MRS. JEANETTE JACKSON (NPI# 1407019797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407019797 |
| Entity Type | Individual |
| Full Name | MRS. JEANETTE JACKSON |
| Credential | LCSW |
| Practice Address |
12422 Nw G T Revell Rd Bristol FL 32321-3007 |
| Practice Telephone | 8506434600 |
| Practice Fax Number | 8506432061 |
| Mailing Telephone | 8506434600 |
| Mailing Fax Number | 8506432061 |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2008-07-07 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
SW6714 | FL | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063058956 | Jeanette Jackson | Counselor | 770 Woodlane Rd, Westampton, NJ 08060-3804 | 2019-11-26 |
| 1396175626 | Jeanette Jackson | Counselor | 4705 N Sonora Ave, Fresno, CA 93722-3966 | 2013-11-22 |
| 1184856239 | Jeanette Jackson | Counselor | 1300 Avenue P, Brooklyn, NY 11229-1106 | 2009-08-21 |
| 1184719023 | Jeanette Helen Jackson | Internal Medicine | 75 Avenue B, Richwood, WV 26261-1236 | 2006-10-04 |
| 1710935820 | Jeanette Jackson | Nurse Anesthetist, Certified Registered | 7703 Floyd Curl Dr, San Antonio, TX 78229-3901 | 2006-05-04 |
| Street Address |
12422 NW G T REVELL RD |
| City | BRISTOL |
| State | FL |
| Zip Code | 32321-3007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134309438 | Keystone Djj, LLC | Counselor | 12422 Nw G T Revell Rd, Bristol, FL 32321-3007 | 2007-11-05 |
| 1124357264 | Kathryn Grace Strickland | Counselor | 12422 Nw G T Revell Rd, Bristol, FL 32321-3007 | 2009-12-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649739194 | Amberly Portero | Counselor | 10611 Florida Highway 20, Bristol, FL 32321 | 2019-03-14 |
| 1194281121 | Ash Bailey Smith | Social Worker | 10659 Nw Sr 20, Bristol, FL 32321 | 2019-02-14 |
| 1508295692 | Maggie Chavez | Counselor | 12422 Ne Revell Road, Bristol, FL 32321 | 2013-11-08 |
| 1437586609 | Queen Brown Haven Assisted Living Facility | Assisted Living Facility | 6906 Nw Torreya Park Road, Bristol, FL 32321 | 2013-10-03 |
| 1538400072 | Ruby Lee Varnum | Assisted Living Facility | 12167 Nw Freeman Rd, Bristol, FL 32321 | 2013-03-08 |
| 1417233321 | April Dawn Landrum | Case Management | 13888 Nw Cr 12, Apalachee Center, Inc., Bristol, FL 32321 | 2011-10-25 |
| 1417191107 | Elizabeth Stephanie Hofrichter | Social Worker | 11033 Nw Sr 20, Bristol, FL 32321 | 2009-04-24 |
| 1275734881 | Efren L Baltazar | Obstetrics & Gynecology | 2571 Executive Center Circle East, Howard Building Division of Disability Determination, Tallahassee, FL 32321 | 2007-05-30 |
| 1336260322 | Laban Bontrager | Dentist | 12761 Ne Pea Ridge Rd, Bristol, FL 32321 | 2007-04-03 |
| 1225192404 | Liberty County School Board | Local Education Agency (LEA) | 12926 Nw Cr 12, Bristol, FL 32321 | 2006-12-21 |
| Find all providers in zip 32321 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053911677 | Linda Rich | Social Worker | 100 Alba Dr, Bristol, CT 06010-2601 | 2020-11-01 |
| 1881225258 | Ellen Repstad | Social Worker | 312 Rockydale Rd, Bristol, VT 05443-5247 | 2020-02-04 |
| 1417591181 | Marita G Daly | Social Worker | 56 Christine Rd, Bristol, CT 06010-3233 | 2019-11-05 |
| 1871143115 | Solid Ground Therapy Solutions LLC | Social Worker | 22 Pine St Ste 103a, Bristol, CT 06010-6949 | 2019-09-18 |
| 1356996169 | Karen Fleenor | Social Worker | 126 Martin Luther King Jr Blvd, Bristol, TN 37620-4078 | 2019-08-08 |
| 1194281121 | Ash Bailey Smith | Social Worker | 10659 Nw Sr 20, Bristol, FL 32321 | 2019-02-14 |
| 1457858193 | Center of Hope Treatment of Attachment & Trauma LLC | Social Worker | 6 6th St Ste 200, Bristol, TN 37620-2589 | 2018-04-10 |
| 1447750484 | Mary Beth Tavares | Social Worker | B6 Bristol Woods Dr, Bristol, RI 02809-2746 | 2018-02-16 |
| 1689048597 | Amy Bernier | Social Worker | 584 Lake Ave, Bristol, CT 06010-0400 | 2015-11-17 |
| 1538573423 | Winter Collins | Social Worker | 12958 Nw Collins Hill Ln, Bristol, FL 32321-3188 | 2014-06-18 |
| Find all providers in BRISTOL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.