Individual
ERIC D JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
35 OLD TAVERN RD, SUITE 103, ORANGE, CT 06477-3450
(203) 701-9666
Mailing address
88 E BROADWAY APT B, MILFORD, CT 06460-6128
(203) 701-9666
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
003329
CT
Other
Enumeration date
02/04/2014
Last updated
02/04/2014
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