Basic Information
| Provider Information | |||||||||
| NPI: | 1619137130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 NW 16TH ST | ||||||||
| Address2: | 116A11 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331251624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055757000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1201 NW 16TH ST | ||||||||
| Address2: | 116A | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331251624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055757000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2008 | ||||||||
| LastUpdateDate: | 03/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH11045 | FL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | ISW10178 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.