Jill J. Jackson, MSW LICSW
Individual provider Active NPI Clinical Social Worker · Wenham, MA
NPI 1740320506 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1740320506
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 105403 (MA)
- Practice address
- 225 Main St
Wenham, MA 01984-1459 - Phone
- (978) 468-1894
- NPI assigned
- Feb 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
- Opted out of Medicare
- Yes, effective May 14, 2018 through May 14, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105403 | MA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 105403 | MA | Yes |
Addresses
Primary practice location
225 Main St
Wenham, MA 01984-1459
Mailing address
225 Main St
Wenham, MA 01984-1459
Phone (978) 468-1894
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 71PO3459 | Other | MA | BCBS PROVIDER # |
Other providers in Wenham, MA
- Harmeling Physical Therapy and Sports Fitness
- Luke Harmeling
- Christine Huntley
- Ihope Network, Inc
- Insight Coaching and Counseling, LLC
- Stephanie Kalanta
- Amy Kolano
- Katherine Larson
- Andre J. Leblanc
- Heather Lewis
All providers in Wenham, MA · Clinical Social Worker in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.