Kimberly Lynn Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ISW01815 Issued in RI

Practice address

1570 Westminster St
Providence, RI 02909

Phone

(215) 607-8480

Fax

(866) 315-9450

NPI assigned

Mar 20, 2007

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

Medicare enrollment (NPD)

Enrolled

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.

• Modern Relationships LLC

  • Clinical Social Worker
  • Philadelphia, PA
  • NPI 1215710652
  NPD Authorized official
• The Providence Center

  • Community/Behavioral Health Agency
  • Providence, RI
  • NPI 1134977598
  NPD (past)

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1841315975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 CHESTNUT ST.",
            "address_2": "SUITE 2 #1497",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19102",
            "telephone_number": "401-575-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 WESTMINSTER ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02909",
            "telephone_number": "215-607-8480",
            "fax_number": "866-315-9450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMBERLY",
        "middle_name": "LYNN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW01815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlotte Jackson, MD
• Chris Jackson, LMHC
• Cynthia Jackson, PH.D.
• Jaissen M Jackson, LMHC
• Joyce Jackson
• Linda Ann Jackson, R.N.
• Syreeta Lea Jackson, LCSW
• Rosalie Judith Jackvony, R.N.
• Jacob Werba DDS LTD
• Isa Mulingbayan Jacoba, MD

• Clinical Social Worker in Providence, RI
• Providers in Providence, RI by specialty
• Clinical Social Worker in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.