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JACKSON PSYCHOLOGICAL, PLLC
NPI 1043072622
Clinic/Center - Mental Health (Including Community Mental Health Center) in Gloversville, NY

Active since January 29, 2024
29 W FULTON ST STE D, GLOVERSVILLE, NY 12078(518) 313-6105(518) 205-7520 Get Directions Write a Review

NPPES record last updated: January 29, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Jackson Psychological, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON PSYCHOLOGICAL, PLLC (NPI 1043072622) is a healthcare organization registered as a mental health (including community mental health center) in Gloversville, New York and active in the NPI registry since January 2024. The organization maintains a secondary practice location in Scotia and lists Melissa Josephine Sheehy Jackson, Owner, as its authorized official.

NPPES Registry Identity

NPI1043072622
Entity TypeOrganization
Primary Taxonomy261QM0801X
Legal Business NameJACKSON PSYCHOLOGICAL, PLLC
Location Address29 W FULTON ST STE DGloversville, NY 12078-2937
Mailing Address29 W Fulton St Ste DGloversville, NY 12078-2937 · (518) 313-6105 · Fax (518) 205-7520
Phone(518) 313-6105
Fax(518) 205-7520
Organization SubpartNo
Authorized OfficialMelissa Josephine Sheehy JacksonOwner · (518) 313-6105
Enumeration DateJanuary 29, 2024
NPPES CertifiedJanuary 29, 2024
✔ NPI 1043072622 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities
Taxonomy Code261QM0801X
29 W FULTON ST STE D, Gloversville, NY 12078
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Secondary Practice Location 1

Location 1106 Mohawk AveScotia, NY 12302-2248 · Phone (518) 313-6105

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jackson Psychological, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Jackson Psychological, PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Melissa Jackson, PH.D.
Clinical Psychologist
NPI 1912106733
29 W FULTON ST STE D
Gloversville, NY 12078
(518) 313-6105
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Psychological, PLLC's NPI number?

The NPI number for Jackson Psychological, PLLC is 1043072622. It was assigned to this organization in the NPPES registry on January 29, 2024.

Where is Jackson Psychological, PLLC located?

Jackson Psychological, PLLC is located at 29 W Fulton St Ste D, Gloversville, NY 12078. The listed phone number is (518) 313-6105.

What is Jackson Psychological, PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Is Jackson Psychological, PLLC enrolled in Medicare?

Yes. Jackson Psychological, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Jackson Psychological, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Jackson Psychological, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Jackson Psychological, PLLC was last updated on January 29, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.