Roberta Marie Jackson, LCSW CASAC-II

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

088300-01 Issued in NY

Practice address

105 W 125TH St
Front 1 #1042
New York, NY 10027-4444

Phone

(347) 654-4405

Fax

(646) 759-4019

NPI assigned

Jan 31, 2020

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. Roberta Marie Walker Former name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2013

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1760013353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 WEST 125TH ST",
            "address_2": "FRONT 1 #1042",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274444",
            "telephone_number": "475-900-6271",
            "fax_number": "646-759-4019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W 125TH ST",
            "address_2": "FRONT 1 #1042",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274444",
            "telephone_number": "347-654-4405",
            "fax_number": "646-759-4019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ROBERTA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW CASAC-II",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-31",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "35723",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "088300-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROBERTA",
            "last_name": "WALKER",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Poppy Christina Jackson, DNP, AGPCNP-BC
• Quiana M Jackson
• Ralph K. Jackson, M.D.
• Reesha Jackson
• Rishona Jackson, M.S. ED
• Ruslana Jackson, NP
• Samuel Jackson
• Sarah Jackson
• Sarah Mackenzie Jackson, MD
• Shawnmarie Loreen Jackson, NP

• Clinical Social Worker in New York, NY
• Providers in New York, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.