Jackson, Brian Frederick

Jackson, Brian Frederick is an sole proprietor health care provider with primary practice located at 4 Back River Rd , Dover NH 03820-4404. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Jackson, Brian Frederick can be contacted via phone (603) 742-1373.

Contact Information

Primary practice address
4 Back River Rd Dover NH 03820-4404
Phone: (603) 742-1373
Fax: (603) 742-1373
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 778 New Hampshire

Profile Details

NPI number 1891887758
LBN Legal business name Jackson, Brian Frederick
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 29th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891887758 NPPES
New Hampshire MEDICAID 30007230

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