Jennifer Lynne Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C-11724 Issued in NM

Practice address

4730 Beckner Road
Santa Fe, NM 87507

Phone

(055) 989-4500

NPI assigned

Feb 11, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Conscious Counseling, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Santa Fe, NM
  • NPI 1679258354
  Medicare reassignment NPD Authorized official
• The Life Link

  • Community/Behavioral Health Agency
  • Santa Fe, NM
  • NPI 1841332400
  NPD (past)

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

{
    "created_epoch": "1423612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696204800000",
    "number": "1124419270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4730 BECKNER ROAD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875074619",
            "telephone_number": "505-989-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 BECKNER ROAD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "87507",
            "telephone_number": "055-989-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JENNIFER",
        "middle_name": "LYNNE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-11",
        "last_updated": "2023-10-02",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NM",
            "license": "M-10624",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NM",
            "license": "C-11724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Rita Jacaruso
• Suzanne Elizabeth Jackiw
• Amy Jackson, D.C.
• Arlena Jackson
• Catherine Jackson, MA
• Mary Alice Jackson
• Tashelle Jackson
• Jacob Daniel Cohen
• Ellen Jacobs, OT
• Henrietta Anne Jacobs, RPH

• Clinical Social Worker in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Clinical Social Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; 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.