Provider Demographics
NPI:1124619960
Name:JACKSON, PILAR EMANI (ICBD, ICEA CERTIFIED)
Entity type:Individual
Prefix:
First Name:PILAR
Middle Name:EMANI
Last Name:JACKSON
Suffix:
Gender:F
Credentials:ICBD, ICEA CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:EASTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-4300
Mailing Address - Country:US
Mailing Address - Phone:864-382-6134
Mailing Address - Fax:
Practice Address - Street 1:50 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:EASTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-4300
Practice Address - Country:US
Practice Address - Phone:864-382-6134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor