Active NPI
Megan Elizabeth Jackson, LMSW
- Clinical Social Worker
- Derby, CT
National Provider Identifier
1790223378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2364
- Practice address
- 30 Elizabeth St
3Rd Floor
Derby, CT 06418-1802 - Phone
- (203) 954-0543
- Fax
- (203) 954-0544
- NPI assigned
- Feb 3, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2364 | CT | Primary |
Addresses
Primary practice location
30 Elizabeth St
3Rd Floor
Derby, CT 06418-1802
Mailing address
12 Plaza Terrace
Apartment E21
Hamden, CT 06514
Phone (203) 954-0543
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2364 | CT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kidsense Therapy Group, LLC | Clinical | Past | Accepting new patients |
| Lower Naugatuck Valley Parent Child Resource Center, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Health Counselor
- Derby, CT
- NPI 1285610584
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486080000000",
"number": "1790223378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 PLAZA TERRACE",
"address_2": "APARTMENT E21",
"city": "HAMDEN",
"state": "CT",
"postal_code": "06514",
"telephone_number": "203-954-0543",
"fax_number": "203-954-0544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 ELIZABETH ST",
"address_2": "3RD FLOOR",
"city": "DERBY",
"state": "CT",
"postal_code": "064181802",
"telephone_number": "203-954-0543",
"fax_number": "203-954-0544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MEGAN",
"middle_name": "ELIZABETH",
"name_prefix": "Ms.",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-03",
"last_updated": "2017-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "2364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Derby, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.