Individual
MELISSA R JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
860 MELROSE AVE, BRONX, NY 10451-4443
(914) 619-7791
Mailing address
217 S WAVERLY ST APT 1A, YONKERS, NY 10701-0801
(914) 619-7791
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000
—
NY
Enumeration date
04/19/2021
Last updated
04/19/2021
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