Caitlin Rebecca Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

220615 Issued in MA

Practice address

2B Harold St
Harwich Port, MA 02646-1517

Phone

(508) 418-8504

NPI assigned

Jul 29, 2021

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1627516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627516800000",
    "number": "1841963485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 MARIGOLD LN",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018104424",
            "telephone_number": "339-999-6440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2B HAROLD ST",
            "city": "HARWICH PORT",
            "state": "MA",
            "postal_code": "026461517",
            "telephone_number": "508-418-8504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CAITLIN",
        "middle_name": "REBECCA",
        "name_prefix": "Miss",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-29",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "220615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220615",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "na",
            "affiliation": "N",
            "address_1": "2B Harold St",
            "city": "Harwich Port",
            "state": "MA",
            "country_code": "US",
            "postal_code": "026461517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tara Hart, NP
• Kaitlyn Lee Hegg, MSW
• Nicole Dareen Hunt
• Lauren Iacovino, BSN, MS, AGPCNP-BC
• Kimberly Anne Irvine, FNP-C
• Sarah F. Johnson, FNP
• Stephanie Jordan
• Michelle Kelly, LICSW
• Adria Marie Kennedy, PMHNP-BC
• Kelly King, MD

• Clinical Social Worker in Harwich Port, MA
• Providers in Harwich Port, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; 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.