Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 0 |
NPI | 1285386599 |
---|---|
Provider Name | Allan James Jackson I |
First Address | Brooklyn, NY 11229-1209 |
Second Address | Brooklyn, NY 11229-1209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2022 |
Last Update Date | 19/01/2022 |