Individual
COURTNEY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
4115 LAKE AVE, ROCHESTER, NY 14612-4813
(585) 324-9273
Mailing address
211 COLLINGWOOD DR, ROCHESTER, NY 14621-1016
(585) 472-6253
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
109152-01
NY
1041C0700X
Clinical Social Worker
109152-01
NY
1041S0200X
School Social Worker
Primary
109152-01
NY
Other
Enumeration date
09/16/2022
Last updated
09/16/2022
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