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General NPI Number Information
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NPI Number | 1033545637
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Entity Type | Organization
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Legal Business Name | CINDYJACKSON,CHILDRENS THERAPY SERVICES
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 1389 W MAIN ST STE 225
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City | WATERBURY
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State | CT
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Zip | 06708-3115
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Country | US
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Telephone | 203-757-1474
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Fax | 203-591-1936
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Provider Business Mailing Address
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Address Line | 1389 W MAIN ST STE 225
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City | WATERBURY
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State | CT
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Zip | 06708-3115
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Country | US
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Telephone | 203-757-1474
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Fax | 203-591-1936
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA JACKSON
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Credential |
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Telephone | 203-271-3288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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