Active NPI
Sidney James Jackson Jr., LSWA
- Social Worker
- Brockton, MA
National Provider Identifier
1801674866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LSWA416877
- Practice address
- 165 Quincy St
Brockton, MA 02302-2988 - Phone
- (508) 897-2031
- NPI assigned
- Sep 20, 2023
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | LSWA416877 | MA | Primary |
Addresses
Primary practice location
165 Quincy St
Brockton, MA 02302-2988
Mailing address
75 Sea Tower Dr
Bridgewater, MA 02324-1654
Phone (339) 832-6367
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 |
|---|---|---|---|
| LSWA416877 | MA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695168000000",
"number": "1801674866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 SEA TOWER DR",
"city": "BRIDGEWATER",
"state": "MA",
"postal_code": "023241654",
"telephone_number": "339-832-6367"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "165 QUINCY ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023022988",
"telephone_number": "508-897-2031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SIDNEY",
"middle_name": "JAMES",
"name_suffix": "Jr.",
"credential": "LSWA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-09-20",
"last_updated": "2023-09-20",
"certification_date": "2023-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "LSWA416877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.