Active NPI
William Charles Jackson, PSY.D
- Health Psychologist
- Boston, MA
National Provider Identifier
1487933438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Psychologist
- Practice address
- 55 Fruit St
Boston, MA 02114-2621 - Phone
- (857) 891-1828
- NPI assigned
- Aug 9, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Health Psychologist | 103TH0004X | Primary |
Addresses
Primary practice location
55 Fruit St
Boston, MA 02114-2621
Mailing address
19 Haslet St # 1
Boston, MA 02131-2933
Phone (857) 891-1828
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10703 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486339200000",
"number": "1487933438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 HASLET ST # 1",
"city": "BOSTON",
"state": "MA",
"postal_code": "021312933",
"telephone_number": "857-891-1828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 FRUIT ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021142621",
"telephone_number": "857-891-1828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "WILLIAM",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-09",
"last_updated": "2017-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.