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

Octavia Mary Jackson

Individual provider Mental Health Counselor · NPI 1588523419

Octavia Mary Jackson is a Mental Health Counselor in Bronx, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2026
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Practice location Address checks out

4215 Park Ave
Bronx, NY 10457-6073
Phone: (917) 870-2097
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence 015528 (NY)

Record details

NPI number1588523419
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 16, 2026
Last updated in NPPESJanuary 16, 2026
Certification dateJanuary 16, 2026

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