Jacquelyn Angela Jackson, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

012735 Issued in NY

Practice address

368 Veterans Memorial Hwy Ste 3
Commack, NY 11725-4322

Phone

(631) 533-0315

NPI assigned

Dec 17, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Sean Tendler Mental Health Counseling, P.C.

  • Mental Health Counselor
  • Commack, NY
  • NPI 1437626025
  Medicare reassignment NPD
• Tidewater Mental Health Counseling PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Huntington Station, NY
  • NPI 1497556088
  NPD Authorized official
• J.Corea Mental Health Counseling PC

  • Exclusive Provider Organization
  • Garden City, NY
  • NPI 1467907733
  NPD (past)

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

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1003575010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "368 VETERANS MEMORIAL HWY STE 3",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117254322",
            "telephone_number": "484-599-1580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "368 VETERANS MEMORIAL HWY STE 3",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117254322",
            "telephone_number": "631-533-0315"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "380 N Broadway Ph E",
            "address_purpose": "LOCATION",
            "city": "Jericho",
            "state": "NY",
            "postal_code": "117532198",
            "country_code": "US",
            "telephone_number": "631-533-0315",
            "fax_number": "855-752-5170",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "65 Air Park Dr Ste 10",
            "address_purpose": "LOCATION",
            "city": "Ronkonkoma",
            "state": "NY",
            "postal_code": "117797374",
            "country_code": "US",
            "telephone_number": "631-533-0315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JACQUELYN",
        "middle_name": "ANGELA",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-17",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "012735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hossam Ismail
• Lauren Elissa Itzler
• Samia Jabbar, MS, CCC-SLP
• Eileen Jackson, NP
• Emily Rose Jackson, LMT
• Sonya Jackson
• Jesu Jacob, D.O.
• Bruce Jacobs
• Samantha Jacobs, LMHC, CASAC
• James C Strickland Psychologist PC

• Mental Health Counselor in Commack, NY
• Providers in Commack, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.