DR. COLLEEN E JACKSON (NPI# 1952765661) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952765661 |
| Entity Type | Individual |
| Full Name | DR. COLLEEN E JACKSON |
| Credential | PH.D. |
| Practice Address |
150 S Huntington Ave Boston Va Medical Center (116b) Boston MA 02130-4817 |
| Practice Telephone | 8573642081 |
| Mailing Telephone | 8573642081 |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2019-04-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | PS01471 | RI | Behavioral Health & Social Service Providers |
| N | 103T00000X | Psychologist | PS01471 | RI | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
PS01471 | RI | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447762844 | Colleen Jackson | Occupational Therapy Assistant | 8011 Elkhart Ave, Lubbock, TX 79424-2615 | 2017-10-26 |
| 1699317263 | Colleen M Jackson | Counselor | 1136 S Delano Ct W Ste B201, Chicago, IL 60605-3734 | 2019-10-15 |
| 1801269840 | Colleen Q Jackson | Licensed Practical Nurse | 224 Harrison St, Suite 680, Syracuse, NY 13202-3056 | 2015-11-12 |
| 1669629275 | Colleen A Jackson | Nutritionist | 101 Hospital Rd, Patchogue, NY 11772-4870 | 2008-08-26 |
| 1134331259 | Colleen Delores Jackson | Nurse Practitioner | 8700 Beverly Blvd, Thalians 2w, Rm 218, West Hollywood, CA 90048-1804 | 2007-05-03 |
| 1346354073 | Colleen Marie Jackson | Durable Medical Equipment & Medical Supplies | 417 E Baltimore St, Unit A, Taneytown, MD 21787-2300 | 2006-08-19 |
| Street Address |
150 S HUNTINGTON AVE BOSTON VA MEDICAL CENTER (116B) |
| City | BOSTON |
| State | MA |
| Zip Code | 02130-4817 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972500429 | Thomas Peter Fantes | Family Medicine | 150 S Huntington Ave, Boston, MA 02130-4817 | 2005-06-30 |
| 1225640758 | Juliette Mcclendon-iacovino | Psychologist | 150 S Huntington Ave, Boston, MA 02130-4817 | 2020-08-17 |
| 1912524232 | William A Delaney | Social Worker | 150 S Huntington Ave, Boston, MA 02130-4817 | 2020-07-02 |
| 1659997948 | Thomas Favale | Dentist | 150 S Huntington Ave, Boston, MA 02130-4817 | 2020-06-22 |
| 1972129385 | Anisha Pandya | Dentist | 150 S Huntington Ave, Boston, MA 02130-4817 | 2020-06-22 |
| 1194347849 | Amanda Vessels | Student in an Organized Health Care Education/Training Program | 150 S Huntington Ave, Boston, MA 02130-4817 | 2020-05-15 |
| 1275155947 | Rachel Nicole Werner | Student in an Organized Health Care Education/Training Program | 150 S Huntington Ave, Boston, MA 02130-4817 | 2020-05-15 |
| 1235750639 | Michelle Lee Bourgeois | Psychologist | 150 S Huntington Ave, Boston, MA 02130-4817 | 2020-04-27 |
| 1962031617 | Tina Khieu | Student in an Organized Health Care Education/Training Program | 150 S Huntington Ave, Boston, MA 02130-4817 | 2020-04-05 |
| 1083240238 | Southey Saul | Psychologist | 150 S Huntington Ave, Boston, MA 02130-4817 | 2020-03-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952913121 | Virginia Dawn Pratt | Social Worker | Ethos, 555 Amory Street, Jamaica Plain, MA 02130 | 2020-08-19 |
| 1689139917 | Lina Skiba | Speech-Language Pathologist | Thom Child & Family Services, 555 Armory St, Jamaica Plain, MA 02130 | 2019-01-31 |
| 1841775442 | Melissa Rocklen | Social Worker | 30 Germania St Bldg C, Jamaica Plain, MA 02130 | 2018-09-28 |
| 1902389281 | Susan N. Berkman | Social Worker | 111 Perkins St., Apt.120, Jamaica Plain, MA 02130 | 2018-09-12 |
| 1326551912 | Cindy Tromp | Counselor | Arbour Hospital, 49 Robinwood Ave, Jamaica Plain, MA 02130 | 2017-11-06 |
| 1811415128 | Jesse Myles Carmen | Social Worker | 555 Armory Street, Jamaica Plain, MA 02130 | 2017-09-07 |
| 1881119410 | Melanie Suzanne Witman | Counselor | 1125 Centre Street, Boston, MA 02130 | 2017-08-04 |
| 1740702125 | Farah Clermont | Counselor | 3815 Washington St., Jamaica Plain, MA 02130 | 2017-07-07 |
| 1346777554 | Anjalie L Pieres | Counselor | 157 Green Streey, Jamaica Plain, MA 02130 | 2017-05-18 |
| 1316480098 | Caroline Amina Shaw-moss | Counselor | 7 Burr St., Boston, MA 02130 | 2016-11-29 |
| Find all providers in zip 02130 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154949873 | Erica Rose Appleman | Clinical Neuropsychologist | 134 Horace St, Boston, MA 02128-1581 | 2020-07-09 |
| 1154870814 | Jessica Pan | Clinical Neuropsychologist | 1 Bowdoin St, 7th Floor, Boston, MA 02114-4201 | 2016-09-22 |
| 1033524913 | Grant Loren Iverson | Clinical Neuropsychologist | Home Base Program, 101 Merrimac Street, 2nd Floor, Boston, MA 02114 | 2014-06-30 |
| 1396175410 | Daniel R. Seichepine | Clinical Neuropsychologist | 725 Albany St # 7b, Boston Medical Center, Boston, MA 02118-2526 | 2013-11-27 |
| 1235566647 | Todd M Solomon | Clinical Neuropsychologist | 72 East Concord Street, B-7800, Boston University School of Medicine, Boston, MA 02118 | 2013-09-30 |
| 1598015984 | Neuropath LLC | Clinical Neuropsychologist | 106 Queensberry St, # 18, Boston, MA 02215-4713 | 2012-09-13 |
| 1619236718 | Justin Centi | Clinical Neuropsychologist | 185 Devonshire St Ste 901b, Boston, MA 02110-1407 | 2012-05-09 |
| 1740513886 | Aparna Rao | Clinical Neuropsychologist | 75 Arlington St, Suite 500, Boston, MA 02116-3936 | 2009-09-08 |
| 1386845998 | Andrea L Piatt | Clinical Neuropsychologist | 321 Columbus Ave Ste 3, Boston, MA 02116-5168 | 2007-05-30 |
| 1417158288 | Robyn Kervick | Clinical Neuropsychologist | 160 Commonwealth Avenue, Suite U3, Boston, MA 02116 | 2007-05-30 |
| Find all providers in BOSTON | ||||
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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.