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General NPI Number Information
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NPI Number | 1679686315
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Entity Type | Individual
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Provider Name | CYNTHIA LERAY JACKSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 200 SOUTH ST CONCERN SUITE 402
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City | MORRISTOWN
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State | NJ
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Zip | 07960-5370
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Country | US
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Telephone | 800-242-7371
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Fax | 973-451-0482
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Provider Business Mailing Address
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Address Line | 95 MT. KEMBLE AVENUE ATTN: C.LAMPRON
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City | MORRISTOWN
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State | NJ
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Zip | 07962-1978
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Country | US
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Telephone | 973-971-4714
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Fax | 973-290-7585
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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 | 44SC01025500
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License Number State | NJ
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