Individual
MISS CAITLIN REBECCA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2B HAROLD ST, HARWICH PORT, MA 02646-1517
(508) 418-8504
Mailing address
6 MARIGOLD LN, ANDOVER, MA 01810-4424
(339) 999-6440
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
220615
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220615
—
MA
Enumeration date
07/29/2021
Last updated
07/29/2021
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