Doris A Jackson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6213 Issued in MA

Practice address

6 Bigelow Street
Cambridge, MA 02139-2384

Phone

(617) 547-0457

NPI assigned

Jun 13, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

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 Psychologist

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760686844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 BIGELOW STREET",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "02139",
            "telephone_number": "617-547-0457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 BIGELOW STREET",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021392384",
            "telephone_number": "617-547-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DORIS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "6213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "W04965",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria Izquiel Bermudez, LCSW
• Lotachi Izuchi
• Zainab Susan Jabur, MD, MPH
• Joanne S Jack, FNP
• Shawn Jackson Dupuy, D.C.
• Joseph Alexander Jackson IV, D.O.
• Kathryn Alice Jackson, PH.D.
• Latoya Shari Jackson, M.D.
• Maggie Virginia Jackson, MSW
• Rose M Jacob, RN

• Clinical Psychologist in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.