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ELIZABETH W JACKSON PHD PLLC
NPI 1306199658
Psychologist - Clinical in Raleigh, NC

Active since October 24, 2012
122 SAINT MARYS ST, RALEIGH, NC 27605(919) 423-2293 Get Directions Write a Review

NPPES record last updated: September 11, 2018. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Elizabeth W Jackson Phd Pllc NPPES

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

ELIZABETH W JACKSON PHD PLLC (NPI 1306199658) is a healthcare organization registered as a clinical in Raleigh, North Carolina and active in the NPI registry since October 2012. The organization lists Elizabeth Wood Jackson, Owner, as its authorized official.

NPPES Registry Identity

NPI1306199658
Entity TypeOrganization
Primary Taxonomy103TC0700X
Legal Business NameELIZABETH W JACKSON PHD PLLC
Location Address122 SAINT MARYS STRaleigh, NC 27605-1809
Mailing Address122 Saint Marys StRaleigh, NC 27605-1809 · (919) 423-2293
Phone(919) 423-2293
Organization SubpartNo
Authorized OfficialElizabeth Wood JacksonOwner · (919) 423-2293
Enumeration DateOctober 24, 2012
Last NPPES UpdateSeptember 11, 2018
✔ NPI 1306199658 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
122 SAINT MARYS ST, Raleigh, NC 27605
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Elizabeth W Jackson Phd 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 Elizabeth W Jackson Phd PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Elizabeth Jackson, PH.D.
Clinical Psychologist
NPI 1477882272
122 SAINT MARYS ST
Raleigh, NC 27605
(919) 423-2293
✔ 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 Elizabeth W Jackson Phd PLLC's NPI number?

The NPI number for Elizabeth W Jackson Phd PLLC is 1306199658. It was assigned to this organization in the NPPES registry on October 24, 2012.

Where is Elizabeth W Jackson Phd PLLC located?

Elizabeth W Jackson Phd PLLC is located at 122 Saint Marys St, Raleigh, NC 27605. The listed phone number is (919) 423-2293.

What is Elizabeth W Jackson Phd PLLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Elizabeth W Jackson Phd PLLC enrolled in Medicare?

Yes. Elizabeth W Jackson Phd PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Elizabeth W Jackson Phd PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Elizabeth W Jackson Phd 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 Elizabeth W Jackson Phd PLLC was last updated on September 11, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.