Healthcare Provider Details

I. General information

NPI: 1821567520
Provider Name (Legal Business Name): VALENTINA S COLON-JACKSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 BRIDGE ST
BROOKLYN NY
11201-5292
US

IV. Provider business mailing address

20934 NORTHERN BLVD # 1050
BAYSIDE NY
11361-3149
US

V. Phone/Fax

Practice location:
  • Phone: 347-940-8601
  • Fax:
Mailing address:
  • Phone: 929-468-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number093947
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number103342
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: