Individual
STEPHANIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
75 NEW SCOTLAND AVE, ALBANY, NY 12208-3409
(518) 447-9611
(518) 426-2902
Mailing address
65 CLIPP RD, DELMAR, NY 12054-5300
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
243144-1
NY
Other
Enumeration date
04/16/2010
Last updated
04/16/2010
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