Roseanne Johnson Jackson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

083560-1 Issued in NY

Practice address

2128 Elmwood Ave
Buffalo, NY 14207-1910

Phone

(716) 874-4500

NPI assigned

Jan 11, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Roseanne Lee Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1263168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476662400000",
    "number": "1700116993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2128 ELMWOOD AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142071910",
            "telephone_number": "716-874-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2128 ELMWOOD AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142071910",
            "telephone_number": "716-874-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ROSEANNE",
        "middle_name": "JOHNSON",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-11",
        "last_updated": "2016-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "083560-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROSEANNE",
            "last_name": "JOHNSON",
            "middle_name": "LEE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kimmerly Jackson, FNP
• Laurletha Renay Jackson
• Melissa Rae Jackson
• Natasha Jackson
• Patricia Jackson, CRNA
• Seolar L Jackson, PMNP-BC
• Shayla N Jackson
• Tamika Marie Jackson, NP-C
• Fatima Marie Jacksonedge, RN
• Sandra Marcey Jacob, NP

• Mental Health Counselor in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.