CRYSTAL JACKSON


Address: 456 Waverly Ave, Patchogue, NY 11772-1586
Phone: 6314476460

CRYSTAL JACKSON (NPI# 1588211692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1588211692
Entity Type Individual
Full Name CRYSTAL JACKSON
Practice Address 456 Waverly Ave
Patchogue
NY 11772-1586
Mailing Address 1 Route 109
West Babylon
NY 11704-6207
Practice Telephone 6314476460
Enumeration Date 2019-08-22
Last Update Date 2019-08-22
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 104100000X Social Worker Behavioral Health & Social Service Providers
Y 104100000X Social Worker NY Behavioral Health & Social Service Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
1 Route 109, West Babylon, NY 117046207 6316695355

Other Providers CRYSTAL JACKSON

NPI Name Taxonomy Address Enumeration
1265081384 Crystal Jackson Specialist/Technologist 2426 Cairns Mill Ct, Charlotte, NC 28269-4083 2019-09-11
1487022919 Crystal Jackson Behavior Technician 3205 Shawnee Trl, Alamogordo, NM 88310 2015-09-15
1598140725 Crystal Jackson Licensed Practical Nurse 1585 Holloway Ray Rd, Mc Intyre, GA 31054-2469 2015-07-29
1336560861 Crystal Jackson Counselor 579 Pimlico Cir, Whitsett, NC 27377-8713 2013-12-31
1215288865 Crystal Jackson Rehabilitation Practitioner 1018 Mosskag Ct, North Las Vegas, NV 89032-7696 2012-09-23
1083879837 Crystal B Jackson Specialist 700 Southlake Cir, Youngsville, LA 70592-5671 2008-07-22
1255595948 Crystal A. Jackson Psychologist 3011 W Grand Blvd Ste 413, Detroit, MI 48202-3011 2008-07-11
1659986586 Crystal E Jackson Behavior Technician 6622 N Maroa Ave, Fresno, CA 93704-1209 2020-09-08
1093349367 Crystal Jackson Counselor 422 E Lamar Blvd Ste 108, Arlington, TX 76011-3604 2020-02-26
1437796919 Crystal Rena Jackson Counselor 8220 Castor Ave, Philadelphia, PA 19152-2729 2019-12-04

Office Location

Street Address 456 WAVERLY AVE
City PATCHOGUE
State NY
Zip Code 11772-1586

Providers in the same location

NPI Name Taxonomy Address Enumeration
1881765618 Federation of Organizations for The New York State Mentally Disabled Case Management 456 Waverly Ave, Patchogue, NY 11772 2006-11-13
1093322901 Jennifer Neithercut Social Worker 456 Waverly Ave, Patchogue, NY 11772-1586 2020-09-24
1396379301 Alyson Rose Paruolo Social Worker 456 Waverly Ave, Patchogue, NY 11772-1586 2020-02-28
1467005967 Meghan Higgins Social Worker 456 Waverly Ave, Patchogue, NY 11772-1586 2019-07-23
1275091563 Eileen Marie Murray Social Worker 456 Waverly Ave, Patchogue, NY 11772-1586 2019-03-06
1205393220 Danielle Marie Greenan Counselor 456 Waverly Ave, Patchogue, NY 11772-1586 2019-02-26
1245797273 Sharon Acosta Social Worker 456 Waverly Ave, Patchogue, NY 11772-1586 2019-02-26
1487119806 Emily Rose Sutton Social Worker 456 Waverly Ave, Patchogue, NY 11772-1586 2019-02-11
1073002671 Jamie Lyn Fleming Social Worker 456 Waverly Ave, Patchogue, NY 11772-1586 2018-05-09
1356856173 Jamie Palm Counselor 456 Waverly Ave, Patchogue, NY 11772-1586 2017-12-04
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1205447224 Amita Vipul Patel Nurse Practitioner Longlsland Community Hospital, 101 Hospital Rd, Patchogue, NY 11772 2020-08-13
1609491968 Sanjib Dey Family Medicine Brookhaven Nephrology Associates, 260 E. Patchogue-yaphank Rd., Patchogue, NY 11772 2020-06-12
1992297204 Camila Bueno-sanchez Student in an Organized Health Care Education/Training Program 676 S Country Rd, East Patchogue, NY 11772 2018-06-01
1184115859 Premier Endodontics of Patchogue Dentist 44 Medford Avenue, Patchogue, NY 11772 2018-05-29
1801386453 Franklin Ikechukwu Ugbode Student in an Organized Health Care Education/Training Program 100 Hospital Road Suite 201, Patchogue, NY 11772 2018-05-18
1508372335 Stephanie Vanschaick Counselor 450 Waverly Ave Ste 11, Patchogue, NY 11772 2017-12-15
1578074498 Chrystal Lee Curran Specialist 1116 Main Road, Aquebogue, NY 11772 2017-10-18
1013457712 Candyce Fahner Registered Nurse 22 Haig Ave, E Patchogue, NY 11772 2017-02-28
1992251631 Vanessa Lynn Petoello Nurse Practitioner 107 N/ Ocean Ave, Suite G, Patchogue, NY 11772 2016-09-01
1811343809 Andrew Vanderlofske Nurse Practitioner 144 North Ocean Avenue, Patchogue, NY 11772 2016-05-09
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Taxonomy Information

Taxonomy Code 104100000X
Grouping Behavioral Health & Social Service Providers
Classification Social Worker

Taxonomy Definition

A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.
Notes: Source: National Association of Social Workers, 2009 [7/1/2009: definition modified]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1447890900 Hope Marie Moore Social Worker 49 Baker St Apt 1, Patchogue, NY 11772-3852 2020-01-13
1588917785 Joshua Hendrickson Social Worker 121 Bailey Ave, Patchogue, NY 11772-3903 2012-10-25
1871876938 Danielle Beth Chebat Social Worker 159 E Woodside Ave, Patchogue, NY 11772-1423 2011-09-26
1306977343 Linda Jean Monahan Social Worker 110 N Ocean Ave, Suite Ll1, Patchogue, NY 11772-2015 2007-03-09
1043362437 Jean Chisholm Sullivan Social Worker 153 Rider Avenue, Patchogue, NY 11772 2007-01-17
1699711879 Diana Ruth Barnett Social Worker 1 South Ocean Ave, Suite 210, Patchogue, NY 11772 2006-06-22
1093322901 Jennifer Neithercut Social Worker 456 Waverly Ave, Patchogue, NY 11772-1586 2020-09-24
1396379301 Alyson Rose Paruolo Social Worker 456 Waverly Ave, Patchogue, NY 11772-1586 2020-02-28
1689210098 Rebecca Lynn Mueller Social Worker 475 E Main St, Patchogue, NY 11772-3121 2019-11-20
1033751110 Zachary Carlton Johnson Social Worker 475 E Main St, Patchogue, NY 11772-3121 2019-10-10
Find all providers in PATCHOGUE

Competitor

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City PATCHOGUE
Zip Code 11772

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Dataset Information

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.

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