Individual
JACKSON L HUECKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRPA-P
Contact information
Practice address
285 VANDERBILT AVE, STATEN ISLAND, NY 10304-2525
(718) 981-4382
Mailing address
20 STRATFORD AVE APT A, STATEN ISLAND, NY 10301-3831
(718) 354-0923
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/10/2022
Last updated
05/10/2022
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