Active NPI
Terrance Richard Jobin, LCSW
- Clinical Social Worker
- Champaign, IL
National Provider Identifier
1922378363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 149001338
- Practice address
- 1723 Georgetown Dr
Champaign, IL 61821-5519 - Phone
- (217) 359-7751
- NPI assigned
- Jan 2, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149001338 | IL | Primary |
Addresses
Primary practice location
1723 Georgetown Dr
Champaign, IL 61821-5519
Mailing address
1723 Georgetown Dr
Champaign, IL 61821-5519
Phone (217) 359-7751
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149001338 | Other | IL | LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149001338 | IL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325462400000",
"number": "1922378363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1723 GEORGETOWN DR",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618215519",
"telephone_number": "217-359-7751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1723 GEORGETOWN DR",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618215519",
"telephone_number": "217-359-7751"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOBIN",
"first_name": "TERRANCE",
"middle_name": "RICHARD",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-01-02",
"last_updated": "2012-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": "149001338",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "149001338",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.