Individual
BENJAMIN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
330 W 28TH ST, 4J, NEW YORK, NY 10001-4722
(917) 514-7478
Mailing address
330 W 28TH ST, 4J, NEW YORK, NY 10001-4722
(917) 514-7478
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0038997-1
NY
Other
Enumeration date
10/30/2013
Last updated
10/30/2013
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