Individual
CORA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
65 POPLAR AVE, PINE PLAINS, NY 12567-5533
(518) 567-3532
Mailing address
65 POPLAR AVE, PINE PLAINS, NY 12567-5533
(518) 567-3532
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
115055
NY
Other
Enumeration date
09/19/2023
Last updated
09/19/2023
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