Provider Demographics
NPI:1033545637
Name:CINDYJACKSON,CHILDRENS THERAPY SERVICES
Entity Type:Organization
Organization Name:CINDYJACKSON,CHILDRENS THERAPY SERVICES
Other - Org Name:CHIDLRENSTHERAPY SERVICES BIRTH TO THREE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-271-3288
Mailing Address - Street 1:1389 W MAIN ST STE 225
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3115
Mailing Address - Country:US
Mailing Address - Phone:203-757-1474
Mailing Address - Fax:203-591-1936
Practice Address - Street 1:1389 W MAIN ST STE 225
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3115
Practice Address - Country:US
Practice Address - Phone:203-757-1474
Practice Address - Fax:203-591-1936
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CINDY JACKSON, CHILDREN'S THERAPY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-16
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty