Healthcare Provider Details

I. General information

NPI: 1639728231
Provider Name (Legal Business Name): BRITTNEY R JACKSON MSW, MBA, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 S MAIN ST STE F
CHESHIRE CT
06410-3436
US

IV. Provider business mailing address

1113 S MAIN ST STE F
CHESHIRE CT
06410-3436
US

V. Phone/Fax

Practice location:
  • Phone: 203-699-6318
  • Fax:
Mailing address:
  • Phone: 203-699-6318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020264
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10742
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7451
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149029138
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34662
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26168
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17730
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: