Jylian Ann Jackson, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

107538 Issued in NY

Practice address

146 Pike Street Outpatient Clinic
Port Jervis, NY 12771

Phone

(845) 858-1456

NPI assigned

Feb 6, 2020

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

Eligible to order & refer

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

Green means eligible to order or refer.

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.

• County of Orange

  • Home Health Agency
  • Goshen, NY
  • NPI 1073016952
  NPD
• County of Orange

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Newburgh, NY
  • NPI 1295889806
  NPD
• County of Orange

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Port Jervis, NY
  • NPI 1740227214
  NPD

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

{
    "created_epoch": "1580947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1982236022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 HARRIMAN DR",
            "city": "GOSHEN",
            "state": "NY",
            "postal_code": "109242410",
            "telephone_number": "845-291-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 PIKE STREET OUTPATIENT CLINIC",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "12771",
            "telephone_number": "845-858-1456"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "141 Broadway",
            "address_purpose": "LOCATION",
            "city": "Newburgh",
            "state": "NY",
            "postal_code": "125506204",
            "country_code": "US",
            "telephone_number": "845-568-5260",
            "fax_number": "845-568-5213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JYLIAN",
        "middle_name": "ANN",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-06",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "107538",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "099243",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hospital Attending Physicians PLLC
• Hospitalist Medicine Physician of New York - Newburgh PC
• Hsien Yu, MD.
• Humble Beginnings Community Services Inc
• J. Ward Fitzpatrick DDS
• Heather Jaeger, NP
• Jeffrey a. Parker, DPM, PC
• Jeremy a. Freeman Psychoanalysis
• Colin B Johnston, DDS
• Daverne Judge, LCSW

• Social Worker in Port Jervis, NY
• Providers in Port Jervis, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.