Jackson Therapy Services LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

05059 Issued in MD

Legal business name

JACKSON THERAPY SERVICES LLC

Practice address

405 Allegheny Ave
Towson, MD 21204-4256

Phone

(908) 839-7117

NPI assigned

Sep 26, 2016

Organization subpart

No

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

Authorized official

Name

Ilana Jackson, PSYDNPI 1104198522

Title

Owner

Phone

(908) 839-7117

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ilana Jackson, PSYD

  • Clinical Psychologist
  • Baltimore, MD
  • NPI 1104198522
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1474848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474848000000",
    "number": "1669921193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SUNNY MEADOW CT",
            "address_2": "APT 102",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212091255",
            "telephone_number": "908-839-7117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 ALLEGHENY AVE",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212044256",
            "telephone_number": "908-839-7117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON THERAPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-26",
        "last_updated": "2016-09-26",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ILANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-839-7117",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "05059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ja Healthcare Services, LLC
• Ja Healthcare Services, LLC
• Kearen Jabaji, MSN, CRNP-PEDS
• Zoe Jack, LMSW
• Jackson Memorial Hospital
• Alexandra Lois Jackson, LCPC
• Bryan Jackson
• Hayley Ruth Jackson, M.S. CCC-SLP
• James Jackson
• Juanita Jackson, LCPC

• Clinical Psychologist in Towson, MD
• Providers in Towson, MD by specialty
• Clinical Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.