Organization
JACKSON CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNISE JACKSON MD (CEO)
(781) 825-5390
Entity
Organization
Contact information
Practice address
33 BEDFORD ST STE 11, LEXINGTON, MA 02420-4403
(781) 825-5390
Mailing address
20 2ND AVE APT 512, BURLINGTON, MA 01803-4463
(228) 712-0012
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
04/21/2022
Last updated
04/21/2022
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