Laurie Ann Jackson, LCSW R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R056949-1 Issued in NY

Practice address

9745 Queens Blvd PH Floor
Rego Park, NY 11374-2101

Phone

(718) 896-9090

Fax

(718) 830-0724

NPI assigned

Oct 18, 2006

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Outreach Development CorporationGroup PAC ID 1355323270, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Outreach Development Corporation

  • Addiction (Substance Use Disorder) Counselor
  • Richmond Hill, NY
  • NPI 1083717326
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1104907187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16832 127TH AVE APT 6",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114343156",
            "telephone_number": "718-525-4864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9745 QUEENS BLVD PH FLOOR",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742101",
            "telephone_number": "718-896-9090",
            "fax_number": "718-830-0724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LAURIE",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LCSW R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R056949-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carl Izask, DDS
• Nadya Izik, RN
• Khusni Izrailova, PHARMD
• Rebecca Izrailova
• Susana Izrailova, N.P.
• Jacob a. Avner, DDS PC
• Arlene Marie Jacobi, RD
• Julia Jacobs
• Andrei-Claudian Jaeger, MD
• Sylvia Jaeger, LCSW

• Clinical Social Worker in Rego Park, NY
• Providers in Rego Park, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.