Brandi Jackson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW19231 Issued in FL

Practice address

1700 Wells Rd Ste 11
Orange Park, FL 32073-2373

Phone

(904) 670-0810

Fax

(904) 670-0818

NPI assigned

Feb 14, 2022

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)

Enrolled

State licenses

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

{
    "created_epoch": "1644796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1962157479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "194 BRENTLEY LN",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320655614",
            "telephone_number": "904-207-3207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 WELLS RD STE 11",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320732373",
            "telephone_number": "904-670-0810",
            "fax_number": "904-670-0818"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "555 Stockton St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322042534",
            "country_code": "US",
            "telephone_number": "904-387-4661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRANDI",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-14",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "SW19231",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW19231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jacksonville Community Midwives LLC
• Jacksonville Emergency Consultants,PA
• Jacksonville Injury & Rehab
• Jacksonville Injury & Rehab

• Clinical Social Worker in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; 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.