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NPI Code Detail

MEDICARE: TONY JACKSON

MEDICARE: TONY JACKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1073841185
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONY JACKSON
Provider Business Mailing Address
First Line : 1526 WALDEN AVE
Second Line : SUITE 400
City : CHEEKTOWAGA
State : NY
Zip : 14225-4965
Country : US
Telephone Number : 716-895-6700
Fax Number : 716-896-0318
Provider Business Practice Location Address
First Line : 150 MOUNT HOPE AVE
Second Line :
City : ROCHESTER
State : NY
Zip : 14620-1016
Country : US
Telephone Number : 585-445-5310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2009
Last Update Date : 02/24/2023

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Directions to “ TONY JACKSON ” Practice Location

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