Active NPI
Gaynella Jackson, LMSW
- Clinical Social Worker
- Southfield, MI
National Provider Identifier
1154445138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801059515
- Practice address
- 20700 Civic Center Dr
Suite 170
Southfield, MI 48076-4140 - Phone
- (248) 569-9846
- Fax
- (248) 569-1919
- NPI assigned
- Mar 16, 2007
- 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 Social Worker | 1041C0700X | 6801059515 | MI | Primary |
Addresses
Primary practice location
20700 Civic Center Dr
Suite 170
Southfield, MI 48076-4140
Mailing address
20700 Civic Center Dr
Suite 170
Southfield, MI 48076-4140
Phone (248) 569-9846
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 80-0-89-6833-0 | Other | MI | BLUE CROSS BLUE SHIELD OF |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801059515 | MI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Intervention Network Inc. | Clinical | Past | 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.
-
- Clinical Social Worker
- Westland, MI
- NPI 1205979234
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1154445138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20700 CIVIC CENTER DR",
"address_2": "SUITE 170",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480764140",
"telephone_number": "248-569-9846",
"fax_number": "248-569-1919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20700 CIVIC CENTER DR",
"address_2": "SUITE 170",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480764140",
"telephone_number": "248-569-9846",
"fax_number": "248-569-1919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "GAYNELLA",
"name_prefix": "Ms.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-16",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801059515",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF",
"identifier": "80-0-89-6833-0",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.