Lisa Olivia Jackson, LMSW, CASAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

076799 Issued in NY

Practice address

1444 5TH Avenue
Family Service League
Bay Shore, NY 11706

Phone

(631) 647-3100

NPI assigned

Jun 12, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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": "1244764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244764800000",
    "number": "1902033350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 CLAYWOOD DR",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117176809",
            "telephone_number": "631-334-1761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1444 5TH AVENUE",
            "address_2": "FAMILY SERVICE LEAGUE",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "11706",
            "telephone_number": "631-647-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LISA",
        "middle_name": "OLIVIA",
        "name_prefix": "Miss",
        "credential": "LMSW, CASAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-12",
        "last_updated": "2009-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "9582",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "076799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Doron Israelski, MD
• Robert Issing, PT,DPT
• J & J Home Care & Surgical Supply Inc.
• Bernice Jackson, NP
• Janea D Jackson
• Casey Jacobson, PA-C
• Veronique Marie-Andree Jacques, DNP MSN FNP-C
• Omkaar Jaikaran
• Alexa Jakacic, PA-C
• Amber James

• Clinical Social Worker in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2009; 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.