Carla Jack, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

10326 68TH Rd
Forest Hills, NY 11375-3200

Phone

(718) 261-3330

NPI assigned

Aug 12, 2015

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 identifiers 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Flushing Hospital & Medical Center

  • General Acute Care Hospital
  • Flushing, NY
  • NPI 1548217763
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  NY

  Medicare reassignment
• Flushing Hospital Medical Center

  • Skilled Nursing Facility
  • Flushing, NY
  • NPI 1568693174
  NPD

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

{
    "created_epoch": "1439337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1780050807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14021 COOMBS ST",
            "city": "SPRINGFIELD GARDENS",
            "state": "NY",
            "postal_code": "114132675",
            "telephone_number": "929-385-6765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10326 68TH RD",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113753200",
            "telephone_number": "718-261-3330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "209 Jamaica Ave # 11",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112072053",
            "country_code": "US",
            "telephone_number": "718-309-7935",
            "fax_number": "718-455-0951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACK",
        "first_name": "CARLA",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-12",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "010630",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS ID",
            "identifier": "634459630",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J&J Star Medical PLLC
• Ja Advance Dentistry, PC
• Ja Gohar Medical
• Sarah Sigalit Jabbour, PSY.D.
• Kathryn Jablon
• Camille Jackson
• Christopher Jackson, LMHC
• Kamala Eva-Marie Jackson, LMSW
• Lauryn Williams Jackson, LMSW
• Melanie Jackson, PA-C

• Mental Health Counselor in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.