Individual
AQUARIUS D JACKOSN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
77 HARTLAND ST STE 108, EAST HARTFORD, CT 06108-3259
(860) 453-5089
Mailing address
35 GINGER LN APT 243, EAST HARTFORD, CT 06118-1298
(203) 904-3113
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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