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KEANU MALIQ JACKSON LCSW
NPI 1740807411
Social Worker in Brooklyn, NY

Active since June 29, 2020
836 BERGEN ST APT 112, BROOKLYN, NY 11238(772) 834-8567 Get Directions Write a Review

NPPES record last updated: March 17, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 17, 2025, Jul 9, 2024, Feb 5, 2024 and 1 more (4 updates tracked since 2020).

About Keanu Maliq Jackson Lcsw NPPES

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

KEANU MALIQ JACKSON LCSW (NPI 1740807411) is an individual social worker in Brooklyn, New York, licensed in New York (096448) and active in the NPI registry since June 2020.

NPPES Registry Identity

NPI1740807411
Entity TypeIndividualMale
Primary Taxonomy104100000X
Provider Legal NameKEANU MALIQ JACKSONCredential: LCSW
Location Address836 BERGEN ST APT 112Brooklyn, NY 11238-7455
Mailing Address836 Bergen St Apt 112Brooklyn, NY 11238-7455 · (772) 834-8567
Phone(772) 834-8567
Sole ProprietorYes
Enumeration DateJune 29, 2020
Last NPPES UpdateMarch 17, 20254 updates tracked since enumeration
NPPES CertifiedMarch 17, 2025
✔ NPI 1740807411 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial WorkerBehavioral Health & Social Service Providers
Taxonomy Code104100000X
License✔ Licensed in NY · 096448
Definition
A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.
836 BERGEN ST APT 112, Brooklyn, NY 11238
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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 Keanu Jackson's NPI number?

The NPI number for Keanu Jackson is 1740807411. It was assigned to this individual provider in the NPPES registry on June 29, 2020.

Where is Keanu Jackson located?

Keanu Jackson practices at 836 Bergen St Apt 112, Brooklyn, NY 11238. The listed phone number is (772) 834-8567.

What is Keanu Jackson's specialty?

The primary specialty registered for this NPI is Social Worker with taxonomy code 104100000X.

When was this NPI record last updated?

The NPPES record for Keanu Jackson was last updated on March 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months 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.