Jackson, Jennifer L

Jackson, Jennifer L is an sole proprietor health care provider with primary practice located at 35 Deforest Ave , Summit NJ 07901-2155. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Family. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Jackson, Jennifer L can be contacted via phone (917) 685-4207.

Contact Information

Primary practice address
35 Deforest Ave Summit NJ 07901-2155
Phone: (917) 685-4207
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 016536 New York
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 016536 New York
Behavioral Health & Social Service Providers / Family 103TF0000X 016536 New York

Profile Details

NPI number 1336360247
LBN Legal business name Jackson, Jennifer L
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 1st, 2007
Last updated Jul 15th, 2010 - about 14 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 1336360247 NPPES
New Jersey Other 4661 LICENSE

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