Miss Lisa Olivia Jackson, LMSW, CASAC is a
Social Worker - Clinical based in Bay Shore, New York. Miss Lisa Olivia Jackson is licensed to practice in New York (license number 076799) and her current practice location is
1444 5th Avenue, Family Service League, Bay Shore, New York. She can be reached at her office (for appointments etc.) via phone at
(631) 647-3100.
NPI number for Miss Lisa Olivia Jackson is 1902033350 and her current mailing address is 195 Claywood Dr, Brentwood, New York. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1902033350.
Healthcare Provider's Profile
| Full Name | Miss Lisa Olivia Jackson |
|---|
| Gender | Female |
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| Speciality | Social Worker - Clinical |
|---|
| Location | 1444 5th Avenue, Bay Shore, New York |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1902033350
- Provider Enumeration Date: 06/12/2009
- Last Update Date: 06/12/2009
Medical Identifiers
Medical identifiers for Miss Lisa Olivia Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1902033350 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 9582 (New York) | Secondary |
| 1041C0700X | Social Worker - Clinical | 076799 (New York) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Miss Lisa Olivia Jackson is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Miss Lisa Olivia Jackson, LMSW, CASAC
195 Claywood Dr,
Brentwood, NY 11717-6809
Ph: (631) 334-1761 | Miss Lisa Olivia Jackson, LMSW, CASAC
1444 5th Avenue, Family Service League,
Bay Shore, NY 11706
Ph: (631) 647-3100 |
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