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Individual

DR. JENNIFER L JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
35 DEFOREST AVE, SUMMIT, NJ 07901-2155
(917) 685-4207
Mailing address
35 DEFOREST AVE, SUMMIT, NJ 07901-2155
(917) 685-4207

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
016536
NY
103TC2200X
Clinical Child & Adolescent Psychologist
016536
NY
103TF0000X
Family Psychologist
016536
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4661
LICENSE
NJ
Enumeration date
05/01/2007
Last updated
07/15/2010
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