Jackey Smith, LCSW, PSYD

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW73218 Issued in CA

Practice address

38127 Versailles St
Palmdale, CA 93552-3523

Phone

(661) 917-1415

NPI assigned

Sep 7, 2016

Last updated

Dec 7, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Marsell Wellness Center

  • Mental Health Counselor
  • Ontario, CA
  • NPI 1700597036
  NPD Authorized official

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1528515483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 PINENUT ST",
            "city": "OAKLEY",
            "state": "CA",
            "postal_code": "945616343",
            "telephone_number": "661-917-1415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38127 VERSAILLES ST",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935523523",
            "telephone_number": "661-917-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACKEY",
        "name_prefix": "Dr.",
        "credential": "LCSW, PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-07",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW73218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "938 Marina Way South",
            "city": "Richmond",
            "state": "CA",
            "country_code": "US",
            "postal_code": "94804",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Audrey Smith
• Bonita Louise Smith
• Brittany D Smith
• Christine E Smith, CSAC1
• Fatima Cecile Smith, RN-PHN
• Lisa Smith
• Miles Smith
• Muriel Francis Smith, LVN
• Rachelle Renee Smith
• Rosio Smith, RN

• Clinical Social Worker in Palmdale, CA
• Providers in Palmdale, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.