Individual
BRIDGETTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
440 N MAIN ST # D, BRISTOL, CT 06010-4990
(860) 314-2052
(860) 314-2054
Mailing address
PO BOX 2828, BRISTOL, CT 06011-2828
(860) 585-3906
(860) 585-3907
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
001126
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004262812
—
CT
Enumeration date
08/01/2006
Last updated
08/08/2007
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