Active NPI
Connie Myerson Jacocks, PH.D.
- Clinical Psychologist
- Denver, CO
National Provider Identifier
1215218599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY0004215
- Practice address
- 720 S Colorado Blvd PH North
Denver, CO 80246-1904 - Phone
- (720) 445-5810
- NPI assigned
- Aug 31, 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 | PSY0004215 | CO | Primary |
Addresses
Primary practice location
720 S Colorado Blvd PH North
Denver, CO 80246-1904
Mailing address
720 S Colorado Blvd PH North
Denver, CO 80246-1904
Phone (720) 445-5810
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2023 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY0004215 | CO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678752000000",
"number": "1215218599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 S COLORADO BLVD PH NORTH",
"city": "DENVER",
"state": "CO",
"postal_code": "802461904",
"telephone_number": "720-445-5810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 S COLORADO BLVD PH NORTH",
"city": "DENVER",
"state": "CO",
"postal_code": "802461904",
"telephone_number": "720-445-5810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOCKS",
"first_name": "CONNIE",
"middle_name": "MYERSON",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-31",
"last_updated": "2023-03-14",
"certification_date": "2023-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "PSY0004215",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.