Rebekah Jackson, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

003182 Issued in CT

Practice address

446A Blake St
Suite 200
New Haven, CT 06515-1286

Phone

(203) 387-9400

Fax

(888) 772-2160

NPI assigned

May 20, 2011

Last updated

Jul 2, 2012By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Integrated Wellness Group, LLC

  • Clinical Child & Adolescent Psychologist
  • New Haven, CT
  • NPI 1003096744
  NPD (past)

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

{
    "created_epoch": "1305849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341187200000",
    "number": "1245523448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446A BLAKE ST",
            "address_2": "SUITE 200",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065151286",
            "telephone_number": "203-387-9400",
            "fax_number": "888-772-2160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "446A BLAKE ST",
            "address_2": "SUITE 200",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065151286",
            "telephone_number": "203-387-9400",
            "fax_number": "888-772-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "REBEKAH",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-20",
        "last_updated": "2012-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CT",
            "license": "003182",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Da'Ja Jackson
• Elisha Jana Jackson, M.D.
• Jessica Jackson, PA-C
• Kamilah Jackson, M.D.
• Krystal Jackson, APRN
• Tabisha Jackson
• Tamiko V Jackson, MD
• Van Rieves Jackson IV, D.P.M.
• Andrea Jacobs-Stannard, P.A.
• Harris C Jacobs, MD

• Psychologist in New Haven, CT
• Providers in New Haven, CT by specialty
• Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; 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.