Individual
DR. ANNISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
33 BEDFORD ST STE 11, LEXINGTON, MA 02420-4403
(781) 825-5390
Mailing address
33 BEDFORD ST STE 11, LEXINGTON, MA 02420-4403
(781) 825-5390
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
280649
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
04/15/2015
Last updated
07/12/2023
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