MEDICARE: NIKIYA FORD-JACKSON LMSW, LGSW, LICSW,

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
1	104100000X	Social Worker	21607	MD
2	104100000X	Social Worker	LC50082168	DC

General Provider Information

NPI Number	:	1881152981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKIYA FORD-JACKSON LMSW, LGSW, LICSW,

Provider Business Mailing Address
First Line	:	10511 BRIGHTFIELD LN
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-2417
Country	:	US
Telephone Number	:	301-221-9549
Fax Number	:

Provider Business Practice Location Address
First Line	:	10511 BRIGHTFIELD LN
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-2417
Country	:	US
Telephone Number	:	301-221-9549
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	07/19/2023

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