Active NPI
Tamara Jackson, PHD
- Psychologist
- Washington, DC
National Provider Identifier
1104314343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY1000266
- Practice address
- 1725 I Street NW
Suite 300
Washington, DC 20006 - Phone
- (202) 349-8471
- NPI assigned
- Apr 24, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY1000266 | DC | Primary |
Addresses
Primary practice location
1725 I Street NW
Suite 300
Washington, DC 20006
Mailing address
4118 Illinois Ave NW
Washington, DC 20011-5950
Phone (202) 558-9488
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY1000266 | DC | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tranquil Haven LLC | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Point of Service
- Washington, DC
- NPI 1477492783
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524528000000",
"number": "1104314343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4118 ILLINOIS AVE NW",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200115950",
"telephone_number": "202-558-9488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1725 I STREET NW",
"address_2": "SUITE 300",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "20006",
"telephone_number": "202-349-8471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TAMARA",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-24",
"last_updated": "2018-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "DC",
"license": "PSY1000266",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.