Sherry Jackson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

113080 Issued in MA

Practice address

108 Camp Fuller Rd
Wakefield, RI 02879-4500

Phone

(401) 633-2682

NPI assigned

Sep 11, 2018

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 11, 2018.

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536624000000",
    "number": "1710460100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 CAMP FULLER RD",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028794500",
            "telephone_number": "401-633-2682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 CAMP FULLER RD",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028794500",
            "telephone_number": "401-633-2682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHERRY",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-11",
        "last_updated": "2018-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "113080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Susan Iacono, APRN FNP-C
• Michael Raymond Iannuccilli, OD
• Savannah Iasimone
• Innovative Works
• Elizabeth Bogardus Ison, LICSW SOCIAL WORKER
• Susan Charlotte Jacobsen, LMHC
• James F. Griffin
• Elise N Jarvis
• Jee Q. Liang, M.D
• Caroline H. Jenckes, CRNP

• All providers in Wakefield, RI
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; 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.