Active NPI
Melissa R Jackson, LMSW
- Assistant Behavior Analyst
- Bronx, NY
National Provider Identifier
1437730785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assistant Behavior Analyst
- Practice address
- 860 Melrose Ave
Bronx, NY 10451-4443 - Phone
- (914) 619-7791
- NPI assigned
- Apr 19, 2021
- 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 |
|---|---|---|---|---|
| Assistant Behavior Analyst | 106E00000X | Primary |
Addresses
Primary practice location
860 Melrose Ave
Bronx, NY 10451-4443
Mailing address
217 S Waverly St Apt 1a
Yonkers, NY 10701-0801
Phone (914) 619-7791
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000 | Medicaid | NY |
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": "1618790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618790400000",
"number": "1437730785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 S WAVERLY ST APT 1A",
"city": "YONKERS",
"state": "NY",
"postal_code": "107010801",
"telephone_number": "914-619-7791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "860 MELROSE AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104514443",
"telephone_number": "914-619-7791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MELISSA",
"middle_name": "R",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-19",
"last_updated": "2021-04-19",
"certification_date": "2021-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "106E00000X",
"taxonomy_group": "",
"desc": "Assistant Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00000",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 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.