Individual
MARY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15 BRANT AVE, SUITE 8, CLARK, NJ 07066-1564
(908) 922-3309
Mailing address
15 BRANT AVE, SUITE 8, CLARK, NJ 07066-1564
(908) 922-3309
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/07/2014
Last updated
07/07/2014
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