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General NPI Number Information
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NPI Number | 1770638462
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Entity Type | Individual
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Provider Name | JACKSON WILLIAMS C.A.S.A.C. - T
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2009 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10029-3208
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Country | US
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Telephone | 121-234-8466
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Fax | 212-348-5427
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Provider Business Mailing Address
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Address Line | 189 ALLEN ST
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City | NEW YORK
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State | NY
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Zip | 10002-1409
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Country | US
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Telephone | 212-673-9342
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | NY
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