Healthcare Provider Details

I. General information

NPI: 1518872803
Provider Name (Legal Business Name): BEN JACKSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 WORCESTER RD
FRAMINGHAM MA
01701-5410
US

IV. Provider business mailing address

42 8TH ST APT 3513
BOSTON MA
02129-4221
US

V. Phone/Fax

Practice location:
  • Phone: 508-628-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: