Richard Warren Jackson Jr., LCSW-BACS, LAC, CCGC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

13630 Issued in LA

Practice address

7732 Goodwood Blvd Ste 102
Baton Rouge, LA 70806-7680

Phone

(504) 517-6390

NPI assigned

Oct 13, 2017

Sex

Male

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

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.

• Baton Rouge Therapie, LLC

  • Clinical Social Worker
  • Baton Rouge, LA
  • NPI 1255033460
  NPD Authorized official

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

{
    "created_epoch": "1507852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679184000000",
    "number": "1891206116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7732 GOODWOOD BLVD STE 102",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708067680",
            "telephone_number": "504-517-6390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7732 GOODWOOD BLVD STE 102",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708067680",
            "telephone_number": "504-517-6390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RICHARD",
        "middle_name": "WARREN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LCSW-BACS, LAC, CCGC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-13",
        "last_updated": "2023-03-19",
        "certification_date": "2023-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "13630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nedrea Chanta Jackson
• Patrice Quinette Jackson
• Phyllis Jackson
• Porsha Marie Jackson, LMSW
• Rabun Dakota Jackson
• Rosa Shenice Jackson
• Shantasia Jackson
• Sharon Jackson, APRN, FNP
• Shawna Jackson
• Shenquie Jackson

• Clinical Social Worker in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Clinical Social Worker in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2023; 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.