Active NPI
Brian Frederick Jackson, PH.D.
- Psychologist
- Dover, NH
National Provider Identifier
1891887758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 778
- Practice address
- 4 Back River Rd
Dover, NH 03820-4404 - Phone
- (603) 742-1373
- Fax
- (603) 742-1373
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 778 | NH | Primary |
Addresses
Primary practice location
4 Back River Rd
Dover, NH 03820-4404
Mailing address
38 Garden LN
Durham, NH 03824-3040
Phone (603) 868-3830
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30007230 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 778 | NH | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891887758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 GARDEN LN",
"city": "DURHAM",
"state": "NH",
"postal_code": "038243040",
"telephone_number": "603-868-3830",
"fax_number": "603-742-1373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 BACK RIVER RD",
"city": "DOVER",
"state": "NH",
"postal_code": "038204404",
"telephone_number": "603-742-1373",
"fax_number": "603-742-1373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BRIAN",
"middle_name": "FREDERICK",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NH",
"license": "778",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30007230",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dover, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.