Carolyn Jane Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW10436 Issued in FL

Practice address

200 S Hoover Blvd
Suite 170
Tampa, FL 33609-3540

Phone

(727) 692-7096

NPI assigned

May 12, 2012

Last updated

May 12, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1336780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336780800000",
    "number": "1063771996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 320331",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336792331",
            "telephone_number": "727-692-7096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S HOOVER BLVD",
            "address_2": "SUITE 170",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336093540",
            "telephone_number": "727-692-7096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CAROLYN",
        "middle_name": "JANE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-12",
        "last_updated": "2012-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW10436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Latrell Jackson, M.A.
• Anthony Shane Jackson, PHARM.D., BCPS
• Benisha Jackson, MS
• Blaire Jackson, CAC
• Brittany Charlette Jackson
• Cherrish M Jackson
• Christopher D'Marius Jackson, MD
• Clare Quirk Jackson, MSPT
• Constance L Jackson, MD
• Darwin C Jackson, MD

• Clinical Social Worker in Tampa, FL
• Providers in Tampa, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.