Individual
GRACENELL PHILEEN JACKSON DAVID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
784 LINDEN BLVD APT 2C, BROOKLYN, NY 11203-3535
(718) 781-2041
Mailing address
784 LINDEN BLVD APT 2C, BROOKLYN, NY 11203-3535
(718) 781-2041
Taxonomy
Speciality
Code
Description
License number
State
225CX0006X
Orientation and Mobility Training Rehabilitation Counselor
Primary
—
—
Other
Enumeration date
07/26/2021
Last updated
07/26/2021
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