Provider Demographics
NPI:1871711291
Name:JACKSON, JOANNE
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 FURNACE DOCK RD
Mailing Address - Street 2:CONDO 1, AJPT. 7
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6534
Mailing Address - Country:US
Mailing Address - Phone:914-736-2235
Mailing Address - Fax:
Practice Address - Street 1:104 GRAND ST
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-2305
Practice Address - Country:US
Practice Address - Phone:914-271-4415
Practice Address - Fax:914-271-4415
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8206-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist