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1740807411
KEANU MALIQ JACKSON
BROOKLYN, NY
NPI
1740807411
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
104100000X Social Worker
(Licence: NY 096448)
Enumeration Date
2020-06-29
Last Update Date
2024-07-09
Business Address
KEANU MALIQ JACKSON LCSW
1217 BEDFORD AVE # 206
BROOKLYN, NY 11216-1801
Phone number: 772-834-8567
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Mailing Address
KEANU MALIQ JACKSON LCSW
836 BERGEN ST APT 112
BROOKLYN, NY 11238-7455
Phone number: 772-834-8567
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