Healthcare Provider Details

I. General information

NPI: 1982984506
Provider Name (Legal Business Name): NAOMI LORRAINE JACKSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. NAOMI LORRAINE MORAN

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9530 HAGEMAN RD STE B #106
BAKERSFIELD CA
93312-3959
US

IV. Provider business mailing address

9530 HAGEMAN RD. STE B #106
BAKERSFIELD CA
93312-3959
US

V. Phone/Fax

Practice location:
  • Phone: 559-576-0812
  • Fax:
Mailing address:
  • Phone: 559-576-0812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: