Nedra Renae Jackson, LCSW, CADC-CAS I

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW99389 Issued in CA

Practice address

550 Elysian Fields Dr
Oakland, CA 94605-5010

Phone

(510) 813-0734

Fax

(510) 638-3828

NPI assigned

Aug 6, 2024

Last updated

Aug 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Nedra Renae Jackson Former name

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

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

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1649000589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 ELYSIAN FIELDS DR",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946055010",
            "telephone_number": "510-813-0734",
            "fax_number": "510-638-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 ELYSIAN FIELDS DR",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946055010",
            "telephone_number": "510-813-0734",
            "fax_number": "510-638-3828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NEDRA",
        "middle_name": "RENAE",
        "credential": "LCSW, CADC-CAS I",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW99389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NEDRA",
            "last_name": "JACKSON",
            "middle_name": "RENAE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael Wayne Jackson, O.D.
• Michele Denise Jackson, RI-J0808181554
• Mikel James Jackson, ATC
• Monique Quai Jackson
• Nathaniel Jackson, RN
• Nicole C. Jackson, LCSW
• Pamela Elaine Jackson, CAS
• Paul A Jackson, PH.D.
• Randall Michael Jackson, PHARMD RPH
• Rebekah Hope Jackson, M.S., OTR/L

• Clinical Social Worker in Oakland, CA
• Providers in Oakland, 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 Aug 6, 2024; 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.