Active NPI
Rachelle Jackson
- Clinical Social Worker
- Benicia, CA
National Provider Identifier
1487958757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 69666
- Practice address
- 110 E D St
Benicia, CA 94510-3254 - Phone
- (707) 342-9551
- NPI assigned
- Dec 31, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 69666 | CA | Primary |
Addresses
Primary practice location
110 E D St
Benicia, CA 94510-3254
Mailing address
PO Box 5093
Vallejo, CA 94591-0509
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 |
|---|---|---|---|
| 69666 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1293753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565308800000",
"number": "1487958757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5093",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945910509",
"fax_number": "707-643-3863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 E D ST",
"city": "BENICIA",
"state": "CA",
"postal_code": "945103254",
"telephone_number": "707-342-9551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RACHELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-12-31",
"last_updated": "2019-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "69666",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benicia, CA
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- Irene Beissner MD Inc
- Heather Rashelle Isom, RADT
- Jackrabbit Shoes and Orthotics, Inc.
- Alexandra Miriam Jansen, LMFT
- Lisa Ann Johnson, MA
- Therese Dale Jones-Garrett, M.F.T.
- Richard G. Joyce, O.D.
- Ruth D. Kalb, PH.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.