1. Home
  2. Directory
  3. New York
  4. Smithtown
  5. Clinic Center
  6. NPI Profile

MISS NICOLE JACKSON
NPI 1972977825
Clinic/Center - Rehabilitation, Substance Use Disorder in Smithtown, NY

Active since November 16, 2015
11 ROUTE 111, SMITHTOWN, NY 11787(631) 920-8300 Get Directions Write a Review

NPPES record last updated: November 16, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Miss Nicole Jackson NPPES

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

MISS NICOLE JACKSON (NPI 1972977825) is an individual rehabilitation, substance use disorder provider in Smithtown, New York, licensed in New York (089076) and active in the NPI registry since November 2015.

NPPES Registry Identity

NPI1972977825
Entity TypeIndividualFemale
Primary Taxonomy261QR0405X
Provider Legal NameMISS NICOLE JACKSON
Location Address11 ROUTE 111Smithtown, NY 11787-3753
Mailing Address11 Route 111Smithtown, NY 11787-3753 · (631) 920-8300
Phone(631) 920-8300
Sole ProprietorYes
Enumeration DateNovember 16, 2015
✔ NPI 1972977825 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rehabilitation, Substance Use DisorderAmbulatory Health Care Facilities
Taxonomy Code261QR0405X
License✔ Licensed in NY · 089076
11 ROUTE 111, Smithtown, NY 11787
Open in Google Maps ↗

Other Providers at the Same Location NPPES 20

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

MR. KEVFOY LENROY FLETCHER MASTERS IN SOCIAL WK
Counselor
11 ROUTE 111
SMITHTOWN, NY 11787
Suffolk County (631) 920-8303
SHAKERIA KERISHA SLATER
Student in an Organized Health Care Education/Training Program
11 ROUTE 111
SMITHTOWN, NY 11787
Suffolk County (631) 920-8303
STEPHANIE GRANATA
Student in an Organized Health Care Education/Training Program
11 ROUTE 111
SMITHTOWN, NY 11787
Suffolk County (631) 920-8300
LAURA CARRANO
Student in an Organized Health Care Education/Training Program
11 ROUTE 111
SMITHTOWN, NY 11787
Suffolk County (631) 920-8306
GAYLE MCCARTHY LCSW
Social Worker (Clinical)
11 ROUTE 111
SMITHTOWN, NY 11787
Suffolk County (631) 920-8300
VAISHNAVI VADDIGIRI M.D.
Psychiatry & Neurology (Psychiatry)
11 ROUTE 111
SMITHTOWN, NY 11787
Suffolk County (631) 920-8300
ALICIA MERCADO
Case Manager/Care Coordinator
11 ROUTE 111
SMITHTOWN, NY 11787
Suffolk County (631) 920-8346
AMANDA M COSTA
Case Manager/Care Coordinator
11 ROUTE 111
SMITHTOWN, NY 11787
Suffolk County (631) 920-8303

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 Nicole Jackson's NPI number?

The NPI number for Nicole Jackson is 1972977825. It was assigned to this individual provider in the NPPES registry on November 16, 2015.

Where is Nicole Jackson located?

Nicole Jackson practices at 11 Route 111, Smithtown, NY 11787. The listed phone number is (631) 920-8300.

What is Nicole Jackson's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rehabilitation, Substance Use Disorder, with taxonomy code 261QR0405X.

When was this NPI record last updated?

The NPPES record for Nicole Jackson was last updated on November 16, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.