Individual
DR. JONATHAN M JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
140 RIVERSIDE DRIVE, 1R, NEW YORK, NY 10024
(212) 580-5974
(516) 877-4844
Mailing address
140 RIVERSIDE DRIVE, 1R, NEW YORK, NY 10024
(212) 580-5974
(516) 877-4844
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
7000
NY
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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