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NPI Code Detail

MEDICARE: MARQUAN JACKSON LLMSW

MEDICARE: MARQUAN JACKSON LLMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6801094159MI
21041C0700XClinical Social Worker0906016293VA

General Provider Information

NPI Number : 1518374297
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARQUAN JACKSON LLMSW
Provider Business Mailing Address
First Line : 1000 1ST ST SE APT 612
Second Line :
City : WASHINGTON
State : DC
Zip : 20003-4921
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10490 LITTLE PATUXENT PKWY STE 600
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-4941
Country : US
Telephone Number : 410-205-6163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2014
Last Update Date : 04/13/2025

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