Active NPI
Roberta Jackson, LBSW
- Clinical Social Worker
- Columbia, SC
National Provider Identifier
1821145137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2120
- Practice address
- 2100 Bull St
Columbia, SC 29201-2104 - Phone
- (803) 935-5572
- Fax
- (803) 935-5566
- NPI assigned
- Jan 5, 2007
- 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 | 2120 | SC | Primary |
Addresses
Primary practice location
2100 Bull St
Columbia, SC 29201-2104
Mailing address
PO Box 11921
Columbia, SC 29211-1921
Phone (803) 935-5572
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 |
|---|---|---|---|
| 2120 | SC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1821145137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11921",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292111921",
"telephone_number": "803-935-5572",
"fax_number": "803-935-5566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 BULL ST",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292012104",
"telephone_number": "803-935-5572",
"fax_number": "803-935-5566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ROBERTA",
"credential": "LBSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "SC",
"license": "2120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.