Colleen Elizabeth Jackson, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

11211 Issued in MA

Practice address

185 Devonshire Street
Suite 902
Boston, MA 02110-1402

Phone

(617) 362-0588

NPI assigned

Apr 8, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Mar 3, 2022 through Mar 3, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1460073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1952765661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 DEVONSHIRE STREET",
            "address_2": "SUITE 902",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021101402",
            "telephone_number": "617-362-0588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 DEVONSHIRE STREET",
            "address_2": "SUITE 902",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021101402",
            "telephone_number": "617-362-0588"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 S Huntington Ave",
            "address_2": "Boston VA Medical Center (116B)",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021304817",
            "country_code": "US",
            "telephone_number": "857-364-2081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "COLLEEN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-08",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "RI",
            "license": "PS01471",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "RI",
            "license": "PS01471",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS01471",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MA",
            "license": "11211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah S. Jackson Oconnor, MD
• Fayette Jackson-Long
• Angela H Jackson, MD
• Ashley Jackson, MSW
• Colin Benjamin Jackson
• Corrin Jackson
• Daniel L Jackson, M.D.
• Deidrya Antoinette Elizabeth Jackson, MD MPH
• Devlin Amanda Jackson, PH.D.
• Esther Jackson

• Clinical Neuropsychologist in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Neuropsychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.