Dawn Jackson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY8115 Issued in FL

Practice address

9900 W Sample Rd Ste 300
Coral Springs, FL 33065-4077

Phone

(954) 320-7881

NPI assigned

Jun 22, 2006

Last updated

Jun 13, 2023By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Psychological Wellness and Growth

  • Adult Mental Health Clinic/Center
  • Coral Springs, FL
  • NPI 1801503396
  NPD Authorized official

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1215973425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 W SAMPLE RD STE 300",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330654077",
            "telephone_number": "954-320-7881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 W SAMPLE RD STE 300",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330654077",
            "telephone_number": "954-320-7881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "015925-1",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY8115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02666544",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J. Audiology, Inc
• J.R.O.a.D Home Health Agency, LLC (Visiting Angels)
• J&J Comprehensive Medical Care LLC
• Scott Mitchell Jablon, DC
• Jacawe Billing Services, Inc.
• Latoya Jackson
• Yvonne Elizabeth Jackson
• Jacky Pepper, Psy D, Inc
• Besty Jacob, O.D.
• Jerry Jacob, CRNA

• Clinical Psychologist in Coral Springs, FL
• Providers in Coral Springs, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.