Mary Y Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

21387 Issued in MD

Practice address

8181 Professional PL Ste 200
Landover, MD 20785-7219

Phone

(301) 306-4590

Fax

(301) 880-0054

NPI assigned

Mar 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Interdynamics, Inc.

  • Psychiatry Physician
  • Landover, MD
  • NPI 1952570343

  Clinical

  NPD
• Interdynamics, Inc.

  • Community/Behavioral Health Agency
  • Landover, MD
  • NPI 1770135261
  NPD (past)

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738800000000",
    "number": "1629109665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 BURGESS LN",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072933",
            "telephone_number": "919-493-3888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8181 PROFESSIONAL PL STE 200",
            "city": "LANDOVER",
            "state": "MD",
            "postal_code": "207857219",
            "telephone_number": "301-306-4590",
            "fax_number": "301-880-0054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "middle_name": "Y",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "MD",
            "license": "21387",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "21387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Interdynamics, Inc.
• Kimberly Ishmell
• Herbert Abifola Ishola
• Amari Jackson
• Kaya Jackson
• Mary Gerald Jacquet, LCSWC
• Sherry Ann James, CRNP
• Jar, Inc.
• Susan Amie Jaward
• Jubemi Jefferson, RBT

• Clinical Social Worker in Landover, MD
• Providers in Landover, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.