Judith Temple Jackson, PSYCHOLOGIST

Primary specialty

Prescribing (Medical) PsychologistTaxonomy code 103TP0016X

License

PS007219L Issued in PA

Practice address

125 Coulter Ave
Floor 2
Ardmore, PA 19003-2410

Phone

(610) 642-4873

Fax

(610) 642-4886

NPI assigned

Apr 22, 2007

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

Other names 1

• Dr. Judith Carol Jackson Former name

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Art of Friendship Social Skills Program, PC

  • Mental Health Counselor
  • Haverford, PA
  • NPI 1801012711
  NPD (past)

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

{
    "created_epoch": "1177200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497973911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 COULTER AVE",
            "address_2": "FLOOR 2",
            "city": "ARDMORE",
            "state": "PA",
            "postal_code": "190032410",
            "telephone_number": "610-642-4873",
            "fax_number": "610-642-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 COULTER AVE",
            "address_2": "FLOOR 2",
            "city": "ARDMORE",
            "state": "PA",
            "postal_code": "190032410",
            "telephone_number": "610-642-4873",
            "fax_number": "610-642-4886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JUDITH",
        "middle_name": "TEMPLE",
        "name_prefix": "Dr.",
        "credential": "PSYCHOLOGIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "PA",
            "license": "PS007219L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUDITH",
            "last_name": "JACKSON",
            "middle_name": "CAROL",
            "prefix": "DR.",
            "credential": "PSYCHOLOGIST",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Infusion Logistics, LLC
• Hillary Rachel Gorman Israeli, VMD
• J & K Optical, Inc.
• J B Merrick Apothecary Inc
• Ashley Denae Jackson
• Moss Alan Jackson, PHD
• James R Hall, OD
• Cassidy Jameson, PT, DPT
• Cecelia Johnson-Dunlap, DO
• Alexandra Johnson, LPC, ATR-BC

• Prescribing (Medical) Psychologist in Ardmore, PA
• Providers in Ardmore, PA by specialty
• Prescribing (Medical) Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.