| Jackson Psychological, Pllc | |
|
29 W Fulton St Ste D Gloversville NY 12078-2937 | |
| (518) 313-6105 | |
| (518) 205-7520 |
| Full Name | Jackson Psychological, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 29 W Fulton St Ste D, Gloversville, New York |
| Authorized Official Name and Position | Melissa Josephine Sheehy Jackson (OWNER) |
| Authorized Official Contact | 5183136105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Psychological, Pllc 29 W Fulton St Ste D Gloversville NY 12078-2937 Ph: (518) 313-6105 | Jackson Psychological, Pllc 29 W Fulton St Ste D Gloversville NY 12078-2937 Ph: (518) 313-6105 |
| NPI Number | 1043072622 |
|---|---|
| Provider Enumeration Date | 01/29/2024 |
| Last Update Date | 01/29/2024 |
| Certification Date | 01/29/2024 |
| Medicare PECOS PAC ID | 1951832021 |
|---|---|
| Medicare Enrollment ID | O20240930002781 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043072622 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Melissa Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912106733 PECOS PAC ID: 3476820432 Enrollment ID: I20170522002621 |
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