Individual provider · Type 1 NPI

Mavis Jackson

Child & Adolescent Psychiatric/Mental Health Registered Nurse · Orangeburg, NY

NPI number 1083455315 Active

Practice location

140 Old Orangeburg Rd
Orangeburg, NY 10962-1157

Mailing address

37 Woodfield Rd
Pomona, NY 10970-2216

Specialties and licenses

TaxonomyCodeLicense
Child & Adolescent Psychiatric/Mental Health Registered Nurse Primary 163WP0807X572849 (NY)

Child & Adolescent Psychiatric/Mental Health Registered Nurse: Definition to come...

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About NPI 1083455315

Mavis Jackson's National Provider Identifier is 1083455315, issued on Jun 3, 2024. The primary taxonomy on file is Child & Adolescent Psychiatric/Mental Health Registered Nurse (163WP0807X), and the practice location is in Orangeburg, NY. The record was last updated on Jun 3, 2024.