Individual
BRIAN FREDERICK JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4 BACK RIVER RD, DOVER, NH 03820-4404
(603) 742-1373
(603) 742-1373
Mailing address
38 GARDEN LN, DURHAM, NH 03824-3040
(603) 868-3830
(603) 742-1373
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
778
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30007230
—
NH
Enumeration date
09/29/2006
Last updated
07/08/2007
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