Individual
MR. BRANDON CLARK JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
7901 BROADWAY, ELMHURST, NY 11373-1329
(718) 396-4515
Mailing address
7901 BROADWAY, ELMHURST, NY 11373-1329
(718) 396-4515
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
101654-1
NY
Other
Enumeration date
04/18/2019
Last updated
03/10/2026
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