Individual provider Active NPI

Marchae Jackson, LMFT

  • Marriage & Family Therapist
  • Fort Lauderdale, FL
National Provider Identifier
1770312951
Registry record updated Jul 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MT4818 Issued in FL
Practice address
1848 SE 1St Ave
Fort Lauderdale, FL 33316-2875
Phone
(954) 885-9500
Fax
(954) 885-9444
NPI assigned
Jul 29, 2024
Last updated
Jul 29, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MT4818 FL Primary

Addresses

Primary practice location

1848 SE 1St Ave
Fort Lauderdale, FL 33316-2875

Mailing address

1848 SE 1St Ave
Fort Lauderdale, FL 33316-2875
Phone (954) 885-9500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20240829004750 FL Practitioner - Marriage and Family Therapist 2062951320 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Transformative Healthcare Solutions Inc CurrentSince Jul 29, 2024 Accepting new patients
Mental Health Center of Florida PA CurrentSince Jul 29, 2024 Accepting new patients
Pro Performance Physical Therapy LLC PastSince Jun 26, 2019 Accepting new patients

Locations

2544 E Sunrise Blvd
Fort Lauderdale, FL 33304
Phone (954) 253-0853

1848 SE 1st Ave
Ft Lauderdale, FL 33316
Phone (954) 366-2700

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1722211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1770312951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 SE 1ST AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162875",
            "telephone_number": "954-885-9500",
            "fax_number": "954-885-9444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1848 SE 1ST AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162875",
            "telephone_number": "954-885-9500",
            "fax_number": "954-885-9444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARCHAE",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-29",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT4818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.