Jennell A Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC05486000 Issued in NJ

Practice address

501 Iron Bridge Rd
Suite 15
Freehold, NJ 07728-5304

Phone

(732) 784-8309

Fax

(732) 782-0429

NPI assigned

Jun 26, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

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.

• Evaluations for Change

  • Clinical Social Worker
  • Toms River, NJ
  • NPI 1598647026
  NPD Authorized official
• Evaluations for Change

  • Mental Health Counselor
  • Toms River, NJ
  • NPI 1912749680
  NPD Authorized official
• Forge Medical Group, LLC

  • Psychiatry Physician
  • West Orange, NJ
  • NPI 1962175026
  NPD
• Forge Medical Group, LLC

  • Psychiatry Physician
  • White Plains, NY
  • NPI 1811561855
  NPD

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458691200000",
    "number": "1841452356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 IRON BRIDGE RD",
            "address_2": "SUITE 15",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077285304",
            "telephone_number": "732-784-8309",
            "fax_number": "732-782-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 IRON BRIDGE RD",
            "address_2": "SUITE 15",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077285304",
            "telephone_number": "732-784-8309",
            "fax_number": "732-782-0429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JENNELL",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-26",
        "last_updated": "2016-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05486000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "311452",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joanne Iwama, LSW
• J C Digiacomo, MD., LLC
• J Calvin Chatlos MD LLC
• Jackson Family Practice LLC
• Alina Jackson, DPT
• Jessica A Jacob
• Syed Ali Jaffari, HIS
• Avish Kumar Jain, DO
• Vini Jain
• Allita I Jaiyeola, BCBA

• Clinical Social Worker in Freehold, NJ
• Providers in Freehold, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; 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.