Provider Demographics
NPI:1982984506
Name:JACKSON, NAOMI LORRAINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:LORRAINE
Last Name:JACKSON
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:NAOMI
Other - Middle Name:LORRAINE
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9530 HAGEMAN RD. STE B #106
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-3959
Mailing Address - Country:US
Mailing Address - Phone:559-576-0812
Mailing Address - Fax:
Practice Address - Street 1:9530 HAGEMAN RD STE B
Practice Address - Street 2:#106
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-3959
Practice Address - Country:US
Practice Address - Phone:559-576-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY35731103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical