Brooke P Jackson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 27339 Issued in CA

Practice address

1044 Sir Francis Drake Blvd
Suite 1
Kentfield, CA 94904-1449

Phone

(415) 609-2361

NPI assigned

Jul 8, 2008

Sex

Female

Sole proprietor

Yes

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

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.

• Brooke P Jackson Psychologist

  • Clinical Psychologist
  • Kentfield, CA
  • NPI 1144838913
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439251200000",
    "number": "1962665067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 SIR FRANCIS DRAKE BLVD",
            "address_2": "SUITE 1",
            "city": "KENTFIELD",
            "state": "CA",
            "postal_code": "949041449",
            "telephone_number": "415-609-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 SIR FRANCIS DRAKE BLVD",
            "address_2": "SUITE 1",
            "city": "KENTFIELD",
            "state": "CA",
            "postal_code": "949041449",
            "telephone_number": "415-609-2361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BROOKE",
        "middle_name": "P",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-08",
        "last_updated": "2015-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 27339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyndra M Holloway
• Gretchen Hoskins, MFT
• Courtenay Irene Houk, MA, LMFT
• Dedalus Hyde, PSY.D.
• Bruce Immerman, M.A. MFT
• Cedric Jackson Jr.
• Dustin Jacobsen
• Bhawna Jain
• Jeanette Rhoads Margolin, M.D.Inc
• John F. Herschleb D.D.S., Inc.

• Clinical Psychologist in Kentfield, CA
• Providers in Kentfield, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.