Yvette Antoinette Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

65069 Issued in CA

Practice address

400 Corporate Pointe
Suite 300
Culver City, CA 90230-7620

Phone

(323) 298-0752

Fax

(323) 298-5893

NPI assigned

Aug 25, 2008

Last updated

May 4, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tender Loving Care Medical Social Worker Agency, Inc.

  • Community/Behavioral Health Agency
  • Culver City, CA
  • NPI 1629382270
  Authorized official Same address or phone

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

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430697600000",
    "number": "1720235476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CORPORATE POINTE",
            "address_2": "SUITE 300",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902307620",
            "telephone_number": "323-298-0752",
            "fax_number": "323-298-5893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CORPORATE POINTE",
            "address_2": "SUITE 300",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902307620",
            "telephone_number": "323-298-0752",
            "fax_number": "323-298-5893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "YVETTE",
        "middle_name": "ANTOINETTE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-25",
        "last_updated": "2015-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "65069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Jackson
• Ladale Jackson Sr.
• Shirley Jackson
• Symone Jackson, LCSW
• Tashe'E Marie Jackson
• Jacob M Tsadok MD Inc
• Jeena Jacob, APRN
• Andrea Jacobo
• Clarissa Jacobo
• Evelyn Jacobo

• Clinical Social Worker in Culver City, CA
• Providers in Culver City, 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 May 4, 2015; 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.