Jacqueline Sara Mollitor, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Hayward, California. Her current practice location is
22245 Main St, Ste 200, Hayward, California. You can reach out to her office (for appointments etc.) via phone at
(510) 600-5139.
Jacqueline Sara Mollitor is licensed to practice in California (license number 75502) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1457542441.
Healthcare Provider's Profile
| Full Name | Jacqueline Sara Mollitor |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 22245 Main St, Hayward, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1457542441
- Provider Enumeration Date: 08/06/2007
- Last Update Date: 02/03/2017
Medicare PECOS Information:
- PECOS PAC ID: 5496175721
- Enrollment ID: I20201026001872
Medical Identifiers
Medical identifiers for Jacqueline Sara Mollitor such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1457542441 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | 30348 (California) | Secondary |
| 1041C0700X | Social Worker - Clinical | 75502 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jacqueline Sara Mollitor allows following entities to bill medicare on her behalf.
| Entity Name | Blue Moon Senior Counseling Of California Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1447678990
PECOS PAC ID: 9335360981
Enrollment ID: O20141023000497 |
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| Entity Name | West Coast Kidney |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1952914681
PECOS PAC ID: 1759700149
Enrollment ID: O20201005001363 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jacqueline Sara Mollitor is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Jacqueline Sara Mollitor, LCSW
22245 Main St, Ste 200,
Hayward, CA 94541-4028
Ph: (510) 600-5139 | Jacqueline Sara Mollitor, LCSW
22245 Main St, Ste 200,
Hayward, CA 94541-4028
Ph: (510) 600-5139 |
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