Individual
MS. TONYETTE M. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
249 VIRGINIA AVE, JERSEY CITY, NJ 07304-1423
(201) 798-9900
Mailing address
PO BOX 407, OLD BRIDGE, NJ 08857-0407
(201) 463-2374
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL05305400
NJ
Other
Enumeration date
11/08/2011
Last updated
11/08/2011
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