Ellen Jackson, LCSW, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC1392 ME Issued in ME

Legal business name

ELLEN JACKSON, LCSW, LLC

Practice address

3 Fundy Road
Suite Two
Falmouth, ME 04105-1796

Phone

(207) 780-9966

Fax

(207) 780-9966

NPI assigned

Mar 20, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Ellen M. R. Jackson, LCSW

Title

Owner

Phone

(207) 780-9966

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1205971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205971200000",
    "number": "1104097948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 FUNDY ROAD",
            "address_2": "SUITE TWO",
            "city": "FALMOUTH",
            "state": "ME",
            "postal_code": "041051796",
            "telephone_number": "207-780-9966",
            "fax_number": "207-780-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 FUNDY ROAD",
            "address_2": "SUITE TWO",
            "city": "FALMOUTH",
            "state": "ME",
            "postal_code": "041051796",
            "telephone_number": "207-780-9966",
            "fax_number": "207-780-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEN JACKSON, LCSW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-20",
        "last_updated": "2008-03-20",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "M. R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-780-9966",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC1392 ME",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Loreto Dunphy, DC
• Timothy Alan Eachus, LCSW
• Emily Christine Echanique, LCSW
• Edgewater Orthopedic Physical Therapy, LLC
• Elizabeth B Eisenhardt, MD
• Stacy Emack, M.S., CCC-SLP
• Chelsea N Emerson, OTR/L
• Donald P Endrizzi, MD
• Ian Kenton Engelman, M.S. CPO
• Catherine Elizabeth Ericson, D.C.

• Clinical Social Worker in Falmouth, ME
• Providers in Falmouth, ME by specialty
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2008; 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.