Individual
MENTIE S JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6 LIBERTY SQ STE 428, BOSTON, MA 02109-5800
(857) 567-8880
Mailing address
106 SUMMER HILL RD, MIDDLETOWN, CT 06457-5646
(404) 840-7272
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10861
CT
Other
Enumeration date
02/18/2026
Last updated
02/18/2026
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