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NPI Code Detail

MEDICARE: ALINA KELLY JACKSON LMHC

MEDICARE: ALINA KELLY JACKSON LMHC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1649942459
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALINA KELLY JACKSON LMHC
Provider Business Mailing Address
First Line : 975 E 181ST ST APT 9A
Second Line :
City : BRONX
State : NY
Zip : 10460-2224
Country : US
Telephone Number : 929-450-8339
Fax Number :
Provider Business Practice Location Address
First Line : 579 COURTLANDT AVE
Second Line :
City : BRONX
State : NY
Zip : 10451-5013
Country : US
Telephone Number : 718-485-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2021
Last Update Date : 01/09/2026

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