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General NPI Number Information
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NPI Number | 1376791699
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Entity Type | Individual
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Provider Name | NIJA LANETTE JACKSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 180 LIVINGSTON ST SUITE #306
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City | BROOKLYN
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State | NY
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Zip | 11201-5861
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Country | US
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Telephone | 718-625-4055
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Fax | 718-228-7829
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Provider Business Mailing Address
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Address Line | 181 MAIN ST # 11743
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City | HUNTINGTON
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State | NY
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Zip | 11743-6918
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Country | US
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Telephone | 631-335-3584
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 093347
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License Number State | NY
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