CHRISTY S. JACKSON, PH.D., LLC (NPI# 1033779533) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033779533 |
| Entity Type | Organization |
| Organization Name | CHRISTY S. JACKSON, PH.D., LLC |
| Practice Address |
352 Main St Durham CT 06422-1645 |
| Mailing Address |
502 Cypress Rd Newington CT 06111-5618 |
| Practice Telephone | 8602666467 |
| Mailing Telephone | 8603010053 |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-06-17 |
| Authorized Official Name | DR. CHRISTY S JACKSON (OWNER) |
| Authorized Official Telephone | 8602666467 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | CHRISTY S. JACKSON, PH.D., LLC. | 26 Shunpike Road, Cromwell, CT 06416 |
| Street Address |
352 MAIN ST |
| City | DURHAM |
| State | CT |
| Zip Code | 06422-1645 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326698333 | Gina Barbetta | Dietitian, Registered | 352 Main St, Durham, CT 06422-1645 | 2019-09-12 |
| 1013567031 | Nourish By Gina LLC | Dietitian, Registered | 352 Main St, Durham, CT 06422-1645 | 2019-09-12 |
| 1174179311 | Evolve Holistic Therapy LLC | Social Worker | 352 Main St, Durham, CT 06422-1645 | 2019-08-14 |
| 1578029377 | Mind Body Counseling LLC | Counselor | 352 Main St, Durham, CT 06422-1645 | 2019-02-16 |
| 1598232936 | Michelle Pellin Ms Ma Lpc LLC | Community/Behavioral Health | 352 Main St, Durham, CT 06422-1645 | 2018-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790999019 | Durham Dental LLC | Dentist | 360 D Main Street, Durham, CT 06422 | 2007-05-09 |
| 1942429014 | Mhs Primary Care | Physician Assistant | 6 Main St., Durham, CT 06422 | 2007-04-25 |
| 1407490717 | Sharon Jean Koch | Social Worker | 80 Plains Rd, Unit 1, Essex, CT 06422 | 2019-10-30 |
| 1013343334 | William Allen Gillespie | Pediatrics | 256 Main St, Durham, CT 06422 | 2013-09-18 |
| 1386993574 | Brownstone Psychological Associates, LLC | Psychologist | 199 Main Street, Durham, CT 06422 | 2012-09-03 |
| 1265469068 | Bradford W Wilkinson | Family Medicine | 6 Main St, Durham, CT 06422 | 2006-06-27 |
| 1851640148 | Debra Shepard Nelson | Psychologist | 199 Main Street, Durham, CT 06422-0002 | 2012-09-03 |
| 1457774978 | Karen Otte | Social Worker | 525 New Haven Rd., Durham, CT 06422-0236 | 2014-02-04 |
| 1396746400 | Amit Patel | Dentist | 28 Elihu Dr, Durham, CT 06422-1025 | 2005-08-10 |
| 1730458068 | Diane Adele Mount Desroches | Registered Nurse | 459r Wallingford Rd, Durham, CT 06422-1124 | 2011-12-15 |
| Find all providers in zip 06422 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932708062 | Daniel Vanhoy Blalock | Psychologist | 411 W Chapel Hill St Ste 600, Durham, NC 27701-3270 | 2020-10-20 |
| 1265048342 | Joseph Giles Winger | Psychologist | 2200 W Main St Erwin Square Plaza, Durham, NC 27710-0001 | 2020-09-23 |
| 1124640537 | Katherine Ramos | Psychologist | 2200 W Main St Ste 300, Durham, NC 27705-4677 | 2020-05-08 |
| 1902436496 | Caitlin Marie Fang | Psychologist | 1200 Broad St Ste 103, Durham, NC 27705-3576 | 2020-01-23 |
| 1194376095 | Craig Daniel Libman | Psychologist | 508 Fulton St Dept 116b, Durham, NC 27705-3875 | 2019-09-23 |
| 1790346617 | Timothy Joseph Strauman | Psychologist | 708 Ivy Meadow Ln, Durham, NC 27707-6183 | 2019-06-21 |
| 1417417262 | Carmen Elisabeth Sanchez | Psychologist | 3326 Durham Chapel Hill Blvd Bldg D, Durham, NC 27707 | 2019-03-20 |
| 1881150795 | Courtney Dutton Cox | Psychologist | 508 Fulton St # 116c, Durham, NC 27705-3875 | 2019-02-15 |
| 1295290104 | Sarah E. Frost | Psychologist | 18 W Colony Pl Ste 280, Durham, NC 27705-5582 | 2019-02-05 |
| 1134639362 | Mark Edward Wolever | Psychologist | 1502 Nc Hwy 54 Wesst, Suite 406, Durham, NC 27707 | 2017-10-02 |
| Find all providers in DURHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.