Jacquona Blackwell

Key facts

NPI

1770428286

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

44SL07433600 (NJ)

Practice address

532 McKinley St
Passaic, NJ 07055-2218

Phone

(862) 383-6823

NPI assigned

Apr 21, 2026

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 21, 2026.

{
    "created_epoch": "1776729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1770428286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "532 MCKINLEY ST",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070552218",
            "telephone_number": "862-383-6823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "532 MCKINLEY ST",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070552218",
            "telephone_number": "862-383-6823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "JACQUONA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-04-21",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SL07433600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Passaic, NJ · Clinical Social Worker in New Jersey