Individual
KRISTINA ASHLEY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2928 W 36TH ST, BROOKLYN, NY 11224-1410
(718) 372-3300
(718) 996-8758
Mailing address
2928 W 36TH ST, BROOKLYN, NY 11224-1410
(718) 372-3300
(718) 996-8758
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
022353
NY
104100000X
Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00057385
—
NY
Enumeration date
06/18/2012
Last updated
10/25/2021
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