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

Mrs. Roberta Marie Jackson, LCSWCASAC-II

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1760013353

Mrs. Roberta Marie Jackson, LCSWCASAC-II is a Clinical Social Worker in New York, New York. Qualified in 2013, 13 years ago. Offers telehealth. Licensed in New York.

Years since qualifying
13
Licensed in
NY
In the registry since
2020
Specialties on file
2
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

105 W 125th St Frnt 1 #1042
New York, NY 10027-4444
Phone: (347) 654-4405
Fax: (646) 759-4019
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 088300-01 (NY)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence 35723 (NY)

Record details

NPI number1760013353
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSWCASAC-II
Sole proprietorNo
NPI enumeratedJanuary 31, 2020
Last updated in NPPESAugust 30, 2024
Certification dateAugust 30, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Accepts Medicare assignment Not indicated
TelehealthOffers telehealth services

Other providers in New York