Active NPI
Chrystina Jackson, LMSW
- Social Worker
- Bohemia, NY
National Provider Identifier
1548867013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 106720
- Practice address
- 80 Orville Dr
Bohemia, NY 11716-2534 - Phone
- (631) 456-3844
- NPI assigned
- Oct 7, 2020
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 106720 | NY | Primary |
Addresses
Primary practice location
80 Orville Dr
Bohemia, NY 11716-2534
Mailing address
PO Box 321
Copiague, NY 11726-0321
Phone (631) 991-1056
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 106720 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602028800000",
"number": "1548867013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 321",
"city": "COPIAGUE",
"state": "NY",
"postal_code": "117260321",
"telephone_number": "631-991-1056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 ORVILLE DR",
"city": "BOHEMIA",
"state": "NY",
"postal_code": "117162534",
"telephone_number": "631-456-3844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CHRYSTINA",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-07",
"last_updated": "2020-10-07",
"certification_date": "2020-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "106720",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bohemia, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.