Individual
CRYSTAL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
456 WAVERLY AVE, PATCHOGUE, NY 11772-1586
(631) 447-6460
Mailing address
1 ROUTE 109, WEST BABYLON, NY 11704-6207
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
NY
104100000X
Social Worker
—
—
Other
Enumeration date
08/22/2019
Last updated
08/22/2019
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