Active NPI
Alexis Jackson
- Social Worker
- Syracuse, NY
National Provider Identifier
1043014475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 122308
- Practice address
- 211 S Lowell Ave # 2
Syracuse, NY 13204-2632 - Phone
- (315) 507-1885
- NPI assigned
- Apr 3, 2025
- Sex
- Unspecified or another gender identity
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 122308 | NY | Primary |
Addresses
Primary practice location
211 S Lowell Ave # 2
Syracuse, NY 13204-2632
Mailing address
211 S Lowell Ave # 2
Syracuse, NY 13204-2632
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 |
|---|---|---|---|
| 122308 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743638400000",
"number": "1043014475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 S LOWELL AVE # 2",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132042632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 S LOWELL AVE # 2",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132042632",
"telephone_number": "315-507-1885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ALEXIS",
"sole_proprietor": "YES",
"sex": "X",
"enumeration_date": "2025-04-03",
"last_updated": "2025-04-03",
"certification_date": "2025-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "122308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.