Active NPI
Charles E. Jackson Jr., LCSW-C, LICSW
- Social Worker
- Baltimore, MD
National Provider Identifier
1720185036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- G10149
- Practice address
- 10 N. Greene Streeet
Baltimore, MD 21201 - Phone
- (410) 605-7279
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | G10149 | MD | Primary |
Addresses
Primary practice location
10 N. Greene Streeet
Baltimore, MD 21201
Mailing address
10 N. Greene Streeet
Baltimore, MD 21201
Phone (410) 605-7279
Medicare participation
Medicare enrollment files- 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G10149 | MD | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199836800000",
"number": "1720185036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 N. GREENE STREEET",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "21201",
"telephone_number": "410-605-7279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 N. GREENE STREEET",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "21201",
"telephone_number": "410-605-7279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CHARLES",
"middle_name": "E.",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "LCSW-C, LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2008-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MD",
"license": "G10149",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; 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.