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1427611151
BRANDON CLARK JACKSON
WOODSIDE, NY
NPI
1427611151
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
104100000X Social Worker
(Licence: NY 101654-1)
Enumeration Date
2019-04-18
Last Update Date
2019-04-18
Business Address
Mr. BRANDON CLARK JACKSON LMSW
42-77 65TH PLACE
WOODSIDE, NY 11377-5054
Phone number: 718-429-2000
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Mailing Address
Mr. BRANDON CLARK JACKSON LMSW
517 E 77TH ST APT 1I
NEW YORK, NY 10075-8865
Phone number: 917-499-8149
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