Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Keanu Maliq Jackson, LCSW

Individual provider Social Worker · NPI 1740807411

Keanu Maliq Jackson, LCSW is a Social Worker in Brooklyn, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2020
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

836 Bergen St Apt 112
Brooklyn, NY 11238-7455
Phone: (772) 834-8567
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Social Worker (primary) Taxonomy 104100000X · Licence 096448 (NY)

Record details

NPI number1740807411
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedJune 29, 2020
Last updated in NPPESMarch 17, 2025
Certification dateMarch 17, 2025

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