Mirissa Jackson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

25215 Issued in MD

Practice address

3771 Stefani Rd
Cantonment, FL 32533-7795

Phone

(850) 607-6910

Fax

(850) 607-6932

NPI assigned

Jun 3, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Relief With Rissa

  • Clinical Social Worker
  • Gambrills, MD
  • NPI 1780306738
  NPD Authorized official

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

{
    "created_epoch": "1559520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1831757905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3771 STEFANI RD",
            "city": "CANTONMENT",
            "state": "FL",
            "postal_code": "325337795",
            "telephone_number": "850-607-6910",
            "fax_number": "850-607-6932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3771 STEFANI RD",
            "city": "CANTONMENT",
            "state": "FL",
            "postal_code": "325337795",
            "telephone_number": "850-607-6910",
            "fax_number": "850-607-6932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MIRISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-03",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "25215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Howell
• Stephanie England Howell, ARNP
• Ingrid Wilson Huang, PH.D.
• Monica Ilaria
• Cheryl Iwanowski
• Ternecia Jackson
• Aleta Johnson
• Deloris Marie Johnson, MS
• Michael James Johnson
• Lauren Taylor Johnston

• Clinical Social Worker in Cantonment, FL
• Providers in Cantonment, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.