Active NPI
Jacqueline Cierra Bobo, LMSW
- Clinical Social Worker
- Conyers, GA
National Provider Identifier
1932864618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- MSW007970
- Practice address
- 2608 Glenbrook LN
Conyers, GA 30012-3696 - Phone
- (662) 816-2969
- NPI assigned
- Nov 8, 2021
- Last updated
- Nov 8, 2021
- Sex
- Female
- 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 | MSW007970 | MS | Primary |
Addresses
Primary practice location
2608 Glenbrook LN
Conyers, GA 30012-3696
Mailing address
2608 Glenbrook LN
Conyers, GA 30012-3696
Phone (662) 816-2969
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 |
|---|---|---|---|
| MSW007970 | MS | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636329600000",
"number": "1932864618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2608 GLENBROOK LN",
"city": "CONYERS",
"state": "GA",
"postal_code": "300123696",
"telephone_number": "662-816-2969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2608 GLENBROOK LN",
"city": "CONYERS",
"state": "GA",
"postal_code": "300123696",
"telephone_number": "662-816-2969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOBO",
"first_name": "JACQUELINE",
"middle_name": "CIERRA",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-11-08",
"last_updated": "2021-11-08",
"certification_date": "2021-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MS",
"license": "MSW007970",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.