Cynthia Jackson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY14155 Issued in CA

Practice address

447 N El Molino Ave
#2
Pasadena, CA 91101-1403

Phone

(626) 577-8480

Fax

(626) 577-8978

NPI assigned

May 26, 2006

Last updated

Jul 20, 2017By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Heritage Clinic and the Community Assistance Program for Seniors

  dba Heritage Clinic Comm for Seniors

  • Clinical Psychologist
  • Pasadena, CA
  • NPI 1306899091
  NPD

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500508800000",
    "number": "1235185653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "447 N EL MOLINO AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911011403",
            "telephone_number": "626-577-8480",
            "fax_number": "626-577-8978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "447 N EL MOLINO AVE",
            "address_2": "#2",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911011403",
            "telephone_number": "626-577-8480",
            "fax_number": "626-577-8978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CYNTHIA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-26",
        "last_updated": "2017-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY14155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Jackson
• Alexander Reuben Jackson
• Allwyne Jackson
• Brittany Jackson
• Charmaine Jackson, LCSW
• Demara Timothy Jackson
• Fatima Jackson, BS
• Katelyn Ann Jackson
• Kayla Jackson
• Kellie Jackson

• Clinical Psychologist in Pasadena, CA
• Providers in Pasadena, 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 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.