Mark Jackson's National Provider Identifier (NPI) Details
Mark Jackson, LCSW
NPI: 1972990844
Enumeration Date: 2015-04-18
Last updated: 2015-04-18
Sole Proprietor: YES
Status: active
Postal Address: 5528 CARTAGENA DR, SARASOTA, FL
Phone: 917-319-1210
Primary Practice Address: 513 MENENDEZ ST, VENICE, FL
Practice's phone: 917-319-1210