| Doctor Name: | LISA JACKSON |
| NPI Number: | 1154711166 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 20111 Horace Harding Expy Oakland Gardens, NY - 113641639 |
| Business Phone Number: | 3476249688 |
| Business Fax Number: | |
| Mailing Address: | 20111 Horace Harding Expy, OAKLAND GARDENS |
| State: | NY |
| Postal Code: | 113641639 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/28/2015 |
| NPI Last Update Date: | 01/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |