Individual
MS. AWILDA JACKANIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
111 EAST 59TH STREET, LIGHTHOUSE INTERNATIONAL, NEW YORK, NY 10022-1202
(212) 821-9239
(212) 821-9710
Mailing address
LIGHTHOUSE INTERNATIONAL 111 EAST 59TH STREET, NEW YORK, NY 10022-1202
(212) 821-9239
(212) 821-9710
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R057061
NY
Other
Enumeration date
07/25/2006
Last updated
07/08/2007
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