Individual provider · Type 1 NPI

Ulysses Jackson

Addiction (Substance Use Disorder) Counselor · Deer Park, NY

NPI number 1376962647 Active

Practice location

89 Washington Ave
Deer Park, NY 11729-6917

Call (631) 767-9294 Map

Fax (631) 767-9294

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400X24980 (NY)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1376962647

Ulysses Jackson's National Provider Identifier is 1376962647, issued on Apr 15, 2014. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Deer Park, NY. The record was last updated on Nov 10, 2025.