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ELIJAH JAGGER JACKSON LCSW
NPI 1669096244
Social Worker - Clinical in Philadelphia, PA

Active since May 30, 2020PECOS Enrolled
201 S 13TH ST APT 1011, PHILADELPHIA, PA 19107(631) 346-8485 Get Directions Write a Review

NPPES record last updated: May 29, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 29, 2023, Mar 22, 2023, Jan 21, 2021 and 1 more (4 updates tracked since 2020).

About Elijah Jagger Jackson Lcsw NPPES

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

ELIJAH JAGGER JACKSON LCSW (NPI 1669096244) is an individual clinical provider in Philadelphia, Pennsylvania, licensed in Pennsylvania (CW023481) and active in the NPI registry since May 2020. He is enrolled in Medicare PECOS and maintains a secondary practice location in Philadelphia.

NPPES Registry Identity

NPI1669096244
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameELIJAH JAGGER JACKSONCredential: LCSW
Location Address201 S 13TH ST APT 1011Philadelphia, PA 19107-5404
Mailing Address201 S 13th St Apt 1011Philadelphia, PA 19107-5404 · (631) 346-8485
Phone(631) 346-8485
Sole ProprietorYes
Enumeration DateMay 30, 2020
Last NPPES UpdateMay 29, 20234 updates tracked since enumeration
NPPES CertifiedMay 28, 2023
✔ NPI 1669096244 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in PA · CW023481
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.
Also ListedSocial WorkerTaxonomy 104100000X
201 S 13TH ST APT 1011, Philadelphia, PA 19107
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Secondary Practice Location 1

Location 11500 Walnut St Ste 300Philadelphia, PA 19102-3502 · Phone (215) 563-7863

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Elijah Jagger Jackson Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 19107 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 $59.88 – $180.99
Typical copayment $0.00 (range $14.97 – $45.24)
Most-billed visit code NA
Established Patient
$74.47 typical visit price
range $19.30 – $147.29
Typical copayment $18.61 (range $4.82 – $36.82)
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.

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 Elijah Jackson's NPI number?

The NPI number for Elijah Jackson is 1669096244. It was assigned to this individual provider in the NPPES registry on May 30, 2020.

Where is Elijah Jackson located?

Elijah Jackson practices at 201 S 13th St Apt 1011, Philadelphia, PA 19107. The listed phone number is (631) 346-8485.

What is Elijah Jackson's specialty?

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

Is Elijah Jackson enrolled in Medicare?

Yes. Elijah Jackson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Elijah Jackson was last updated on May 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.