Individual
ALICIA CAROL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
01/31/05
Contact information
Practice address
2094 PITKIN AVE, BROOKLYN, NY 11207-3509
(718) 240-0602
(718) 240-0601
Mailing address
3520 24TH ST, APT. 6F, LONG ISLAND CITY, NY 11106-4470
(718) 706-8097
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
069227-1
NY
Other
Enumeration date
11/02/2006
Last updated
07/08/2007
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