DR. COLLEEN E JACKSON


Address: 150 S Huntington Ave, Boston Va Medical Center (116b), Boston, MA 02130-4817
Phone: 8573642081

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).

Provider Overview

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

Taxonomy

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

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Office Location

Street Address 150 S HUNTINGTON AVE
BOSTON VA MEDICAL CENTER (116B)
City BOSTON
State MA
Zip Code 02130-4817

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 103G00000X
Grouping Behavioral Health & Social Service Providers
Classification Clinical Neuropsychologist

Taxonomy Definition

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]

Providers in the same taxonomy and city

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
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Competitor

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City BOSTON
Zip Code 02130

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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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