=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083171995
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN JACKSON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2019
-----------------------------------------------------
Last Update Date | 07/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 POST RD E # 265
-----------------------------------------------------
City | WESTPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06880-4431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-203-1773
-----------------------------------------------------
Fax | 646-665-4427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 WOODSIDE GRN APT 1B
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06905-4913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149.025913
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 10532
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------