Brooke P Jackson Psychologist

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

BROOKE P JACKSON PSYCHOLOGIST

Practice address

1044 Sir Francis Drake Blvd Ste 1
Kentfield, CA 94904-1454

Phone

(415) 609-2361

NPI assigned

Jul 17, 2020

Last updated

Jul 17, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brooke P Jackson, PSYDNPI 1962665067

Title

Owner

Phone

(415) 609-2361

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brooke P Jackson, PSY.D.

  • Clinical Psychologist
  • Kentfield, CA
  • NPI 1962665067
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1594944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594944000000",
    "number": "1144838913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 SIR FRANCIS DRAKE BLVD STE 1",
            "city": "KENTFIELD",
            "state": "CA",
            "postal_code": "949041454",
            "telephone_number": "415-609-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 SIR FRANCIS DRAKE BLVD STE 1",
            "city": "KENTFIELD",
            "state": "CA",
            "postal_code": "949041454",
            "telephone_number": "415-609-2361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKE P JACKSON PSYCHOLOGIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-17",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "415-609-2361",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Boghrati, MFT
• David John Borgeson, MPT, MS
• Linda Christine Boyd-Cornell, L.M.F.T.
• Cynthia Bradley, DOULA
• Pierre Brennan, MM, MT-BC, NMT, BCBA
• Eileen Cohune Brown, LMFT
• Susan Denise Brownridge, D.P.T.
• Buckelew Programs
• Taylor Bunkers
• Alan S Cascio, DDS

• Clinical Psychologist in Kentfield, CA
• Providers in Kentfield, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.