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DOMONIQUE JACKSON LCSW
NPI 1063950731
Social Worker - Clinical in Orange Park, FL

Active since February 02, 2017Opted out of Medicare · through Oct 1, 2027
752 BLANDING BLVD STE 130, ORANGE PARK, FL 32065(904) 637-5297 Get Directions Write a Review

NPPES record last updated: June 25, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 25, 2020, May 2, 2019, Feb 2, 2017 (3 updates tracked since 2017).

About Domonique Jackson Lcsw NPPES

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

DOMONIQUE JACKSON LCSW (NPI 1063950731) is an individual clinical provider in Orange Park, Florida and active in the NPI registry since February 2017. She has opted out of Medicare through October 1, 2027 and remains eligible to order and refer and maintains a secondary practice location in Jacksonville.

NPPES Registry Identity

NPI1063950731
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameDOMONIQUE JACKSONCredential: LCSW
Location Address752 BLANDING BLVD STE 130Orange Park, FL 32065-5790
Mailing Address3045 Russell RdGreen Cove Springs, FL 32043-8209 · (904) 505-1844
Phone(904) 637-5297
Sole ProprietorNo
Enumeration DateFebruary 2, 2017
Last NPPES UpdateJune 25, 20203 updates tracked since enumeration
NPPES CertifiedJune 25, 2020
✔ NPI 1063950731 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
752 BLANDING BLVD STE 130, Orange Park, FL 32065
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Secondary Practice Location 1

Location 13100 University Blvd S Ste 218Jacksonville, FL 32216-2727 · Phone (904) 535-1844

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company), Oscar Health Maintenance Organization of Florida and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Domonique Jackson Lcsw has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 1, 2023 through October 1, 2027.

Opt-Out Effective DateOctober 1, 2023
Opt-Out In Effect ThroughOctober 1, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32065 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $56.00 – $171.84
Typical copayment $0.00 (range $14.00 – $42.96)
Most-billed visit code NA
Established Patient
$70.04 typical visit price
range $17.57 – $139.16
Typical copayment $17.51 (range $4.39 – $34.79)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FULL CONNECTIONS COUNSELING
Community/Behavioral Health
752 BLANDING BLVD STE 130
ORANGE PARK, FL 32065
Clay County (904) 637-5297

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 Domonique Jackson's NPI number?

The NPI number for Domonique Jackson is 1063950731. It was assigned to this individual provider in the NPPES registry on February 2, 2017.

Where is Domonique Jackson located?

Domonique Jackson practices at 752 Blanding Blvd Ste 130, Orange Park, FL 32065. The listed phone number is (904) 637-5297.

What is Domonique Jackson's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Domonique Jackson enrolled in Medicare?

No. Domonique Jackson has opted out of Medicare through October 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Domonique Jackson accept?

Health plans from Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company), Oscar Health Maintenance Organization of Florida and UnitedHealthcare list Domonique Jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Domonique Jackson was last updated on June 25, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.