Individual
DR. CAROLYN TRISH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
125 BROOKLEY RD, ROME, NY 13441-4301
(315) 334-7100
Mailing address
125 BROOKLEY RD, ROME, NY 13441-4301
(315) 334-7100
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
018985
NY
Other
Enumeration date
02/28/2011
Last updated
02/28/2011
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