Individual
CHRYSTINA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
80 ORVILLE DR, BOHEMIA, NY 11716-2534
(631) 456-3844
Mailing address
PO BOX 321, COPIAGUE, NY 11726-0321
(631) 991-1056
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
106720
NY
Other
Enumeration date
10/07/2020
Last updated
10/07/2020
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