Active NPI
Adriaenna Jackson-Adams
- Addiction (Substance Use Disorder) Counselor
- Roxbury, MA
National Provider Identifier
1366813289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 25725
- Practice address
- 520 Dudley St
Roxbury, MA 02119-2769 - Phone
- (617) 785-7723
- Fax
- (617) 445-2672
- NPI assigned
- Oct 19, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 25725 | Primary |
Addresses
Primary practice location
520 Dudley St
Roxbury, MA 02119-2769
Mailing address
520 Dudley St
Roxbury, MA 02119-2769
Phone (617) 785-7723
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 043082352 | Other | MA | MASS HEALTH -MBHP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447113600000",
"number": "1366813289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 DUDLEY ST",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021192769",
"telephone_number": "617-785-7723",
"fax_number": "617-445-2672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 DUDLEY ST",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021192769",
"telephone_number": "617-785-7723",
"fax_number": "617-445-2672"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON-ADAMS",
"first_name": "ADRIAENNA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-19",
"last_updated": "2015-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": "25725",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASS HEALTH -MBHP",
"identifier": "043082352",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.