Gracenell Phileen Jackson David

Primary specialty

Orientation and Mobility Training Rehabilitation CounselorTaxonomy code 225CX0006X

Practice address

784 Linden Blvd Apt 2C
Brooklyn, NY 11203-3535

Phone

(718) 781-2041

NPI assigned

Jul 26, 2021

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

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1366115412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "784 LINDEN BLVD APT 2C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112033535",
            "telephone_number": "718-781-2041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "784 LINDEN BLVD APT 2C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112033535",
            "telephone_number": "718-781-2041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON DAVID",
        "first_name": "GRACENELL",
        "middle_name": "PHILEEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-26",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225CX0006X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor, Orientation and Mobility Training Provider",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Daria C Jackson-Legagneur
• Tanya Olaiya Jackson-Soufiane, DPM
• Alicia Jackson, LMSW
• Alicia Carol Jackson, 01/31/05

• Rehabilitation Counselor in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Rehabilitation Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 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.