Jackson, Lisa Ann

Jackson, Lisa Ann is an sole proprietor health care provider with primary practice located at 4955 N Bailey Ave , Amherst NY 14226-1206. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Neuropsychologist, which is considered as her primary health care specialty. Jackson, Lisa Ann can be contacted via phone (716) 833-0292.

Contact Information

Primary practice address
4955 N Bailey Ave Amherst NY 14226-1206
Phone: (716) 833-0292
Fax: (716) 833-0215
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X 011968 New York

Profile Details

NPI number 1316071749
LBN Legal business name Jackson, Lisa Ann
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 15th, 2007
Last updated Jul 8th, 2007 - about 19 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 1316071749 NPPES
New York MEDICAID 01474937

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