Active NPI
Daisy Jackson, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1114215241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 02728-1
- Practice address
- 3 Columbus Cir
New York, NY 10019-1903 - Phone
- (121) 224-6574
- NPI assigned
- Jul 11, 2011
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 02728-1 | NY | Primary |
Addresses
Primary practice location
3 Columbus Cir
New York, NY 10019-1903
Mailing address
353 Lexington Ave Ste 407
New York, NY 10016-0941
Phone (646) 470-1226
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 |
|---|---|---|---|
| 02728-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759968000000",
"number": "1114215241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "353 LEXINGTON AVE STE 407",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100160941",
"telephone_number": "646-470-1226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 COLUMBUS CIR",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100191903",
"telephone_number": "121-224-6574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DAISY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-11",
"last_updated": "2025-10-09",
"certification_date": "2025-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "02728-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.