Provider Demographics
NPI:1538155247
Name:MOUJID, BOBBI-JO LISA (LICSW)
Entity type:Individual
Prefix:
First Name:BOBBI-JO
Middle Name:LISA
Last Name:MOUJID
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SIBLEY ST STE 500
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1938
Mailing Address - Country:US
Mailing Address - Phone:651-256-1274
Mailing Address - Fax:
Practice Address - Street 1:400 SIBLEY ST STE 500
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1938
Practice Address - Country:US
Practice Address - Phone:651-256-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN217G9AZOtherBLUE CROSS BLUE SHIELD
MN990991042512OtherPREFERRED ONE
MN1000OtherMHP
MN113155OtherUCARE
MN198428400Medicaid
MN800001602Medicare ID - Type UnspecifiedMEDICARE