Kristina Ashley Jackson, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

022353 Issued in NY

Practice address

2928 W 36TH St
Brooklyn, NY 11224-1410

Phone

(718) 372-3300

Fax

(718) 996-8758

NPI assigned

Jun 18, 2012

Sex

Female

Sole proprietor

Yes

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

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

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1225391006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2928 W 36TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112241410",
            "telephone_number": "718-372-3300",
            "fax_number": "718-996-8758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2928 W 36TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112241410",
            "telephone_number": "718-372-3300",
            "fax_number": "718-996-8758"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3512 Quentin Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112344245",
            "country_code": "US",
            "telephone_number": "800-275-3243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KRISTINA",
        "middle_name": "ASHLEY",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "022353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00057385",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaedrea Jackson, M.D.
• Kathleen Elizabeth Jackson, MSW
• Keanu Maliq Jackson, LCSW
• Kim Janice Jackson
• Kimberly A Jackson, PMHNP, FNP
• Lashanda M Jackson
• Leslie J Jackson, LCSW
• Lindsey Renae Jackson
• Lisa Nicole Jackson, LPN
• Marcia Dawn Jackson, LPN

• Clinical Psychologist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.