Individual provider Active NPI

Jennifer Louise Jackson, LCSW

  • Clinical Social Worker
  • San Francisco, CA
National Provider Identifier
1548584535
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
21474 Issued in CA
Practice address
1721 Scott St
Suite 3B
San Francisco, CA 94115-3035
Phone
(415) 710-2078
Fax
(415) 824-1448
NPI assigned
Mar 18, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 21474 CA Primary

Addresses

Primary practice location

1721 Scott St
Suite 3B
San Francisco, CA 94115-3035

Mailing address

3167 Coolidge Ave Unit a
Oakland, CA 94602-2711
Phone (415) 730-5857

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240208002896 CA Practitioner - Clinical Social Worker 9032552849 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Alameda Health System Current Accepting new patients
Alameda Health System CurrentSince Jan 1, 2024 Accepting new patients
Alameda Health System CurrentSince Jan 1, 2024 Accepting new patients

Locations

15400 Foothill Blvd
Castro Valley, CA 94578
Phone (510) 346-1468

1411 E 31st St
Oakland, CA 94602
Phone (510) 437-4323

7677 Oakport St
Ste 1200
Oakland, CA 94621
Phone (510) 618-5768

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1548584535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3167 COOLIDGE AVE UNIT A",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946022711",
            "telephone_number": "415-730-5857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 SCOTT ST",
            "address_2": "SUITE 3B",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941153035",
            "telephone_number": "415-710-2078",
            "fax_number": "415-824-1448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JENNIFER",
        "middle_name": "LOUISE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-18",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "21474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.