Alysa Michele Jackson, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

075695 Issued in NY

Practice address

3000 'J' Street,
Federal Medical Center, Carswell
Fort Worth, TX 76127

Phone

(817) 782-4002

NPI assigned

May 3, 2006

Last updated

Oct 10, 2016By 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": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476057600000",
    "number": "1073571428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5425 DEER ISLAND DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761791481",
            "telephone_number": "254-833-0663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 'J' STREET,",
            "address_2": "FEDERAL MEDICAL CENTER, CARSWELL",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76127",
            "telephone_number": "817-782-4002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALYSA",
        "middle_name": "MICHELE",
        "name_prefix": "Ms.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-03",
        "last_updated": "2016-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "075695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reginald Jack
• Jamie Jackman, MS CNIM
• Sarah Jacks, LPC
• Jacksboro Smiles by Wire, PLLC (All Smiles Dental & Orthodontics)
• Ahrielle Jackson
• Ashli Brooke Jackson, RN
• Breaunnah Bloomer Jackson, MD
• Bree Jackson, BCBA
• Charles Jackson
• Chrystal Mae Jackson, COTA

• Clinical Social Worker in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; 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.