Individual
ROSA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LGSW
Contact information
Practice address
1900 N HOWARD ST STE 300, BALTIMORE, MD 21218-5909
(443) 438-6742
Mailing address
3805 RIDGEWOOD AVE, BALTIMORE, MD 21215-5610
(443) 803-6416
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
22806
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
383876389
—
MD
Enumeration date
06/28/2017
Last updated
06/30/2017
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