| Brooke P Jackson Psychologist | |
|
1044 Sir Francis Drake Blvd Ste 1 Kentfield CA 94904-1454 | |
| (415) 609-2361 | |
| Not Available |
| Full Name | Brooke P Jackson Psychologist |
|---|---|
| Speciality | Psychologist |
| Location | 1044 Sir Francis Drake Blvd Ste 1, Kentfield, California |
| Authorized Official Name and Position | Brooke P Jackson (OWNER) |
| Authorized Official Contact | 4156092361 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brooke P Jackson Psychologist 1044 Sir Francis Drake Blvd Ste 1 Kentfield CA 94904-1454 Ph: (415) 609-2361 | Brooke P Jackson Psychologist 1044 Sir Francis Drake Blvd Ste 1 Kentfield CA 94904-1454 Ph: (415) 609-2361 |
| NPI Number | 1144838913 |
|---|---|
| Provider Enumeration Date | 07/17/2020 |
| Last Update Date | 07/17/2020 |
| Certification Date | 07/17/2020 |
| Medicare PECOS PAC ID | 6002232196 |
|---|---|
| Medicare Enrollment ID | O20200819004146 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144838913 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Brooke Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1962665067 PECOS PAC ID: 0244540458 Enrollment ID: I20151029002906 |
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