Jennifer M Derner, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

005064 Issued in MO

Practice address

128 Oak Tree Dr
Saint Louis, MO 63119-4760

Phone

(314) 328-5701

Fax

(314) 408-8400

NPI assigned

May 1, 2018

Last updated

Jul 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Profero Counseling and Consulting LLC

  • Clinical Social Worker
  • Saint Louis, MO
  • NPI 1235819707
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689811200000",
    "number": "1851889281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9051 WATSON RD #134",
            "city": "CRESTWOOD",
            "state": "MO",
            "postal_code": "631262220",
            "telephone_number": "314-328-5701",
            "fax_number": "314-408-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 OAK TREE DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631194760",
            "telephone_number": "314-328-5701",
            "fax_number": "314-408-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERNER",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-01",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "005064",
            "primary": true
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dermatological Care, Inc.
• Dermatology and Cutaneous Surgery, Inc
• Dermatology Associates, Inc.
• Dermatology Consultants, P.C. (Fred D. Bauschard, M.D.)
• Elizabeth Catherine Dermody
• Jori Marie Derner, PNP
• Courtney Deronde, BCBA
• Michael J Derosa, M.D.
• Lori Derosear, D.O.
• Edward Justin Derrick, MD

• Clinical Social Worker in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.