Individual
SHAUNTAY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
2541 OLINVILLE AVE APT 4B, BRONX, NY 10467-7491
(347) 318-7140
Mailing address
2541 OLINVILLE AVE APT 4B, BRONX, NY 10467-7491
(347) 318-7140
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
002627-01
NY
Other
Enumeration date
04/14/2022
Last updated
12/30/2025
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