Healthcare Provider Details

I. General information

NPI: 1245670454
Provider Name (Legal Business Name): BRITTANY JACKSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5951 JEFFERSON ST NE STE C
ALBUQUERQUE NM
87109-3450
US

IV. Provider business mailing address

4620 E CAMINO CASA REDONDO
TUCSON AZ
85718-3506
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4900
  • Fax:
Mailing address:
  • Phone: 505-366-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0658
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-18272
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: