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1083455315
MAVIS JACKSON
ORANGEBURG, NY
NPI
1083455315
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
163WP0807X Registered Nurse Psychiatric/Mental Health, Child & Adolescent
(Licence: NY 572849)
Enumeration Date
2024-06-03
Last Update Date
2024-06-03
Business Address
MAVIS JACKSON
140 OLD ORANGEBURG RD
ORANGEBURG, NY 10962-1157
Phone number: 845-680-7800
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Mailing Address
MAVIS JACKSON
37 WOODFIELD RD
POMONA, NY 10970-2216
Phone number:
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