Provider Demographics
NPI:1083742431
Name:JACKSON, FLORENCE A (SOCIAL WORKER II)
Entity Type:Individual
Prefix:MS
First Name:FLORENCE
Middle Name:A
Last Name:JACKSON
Suffix:
Gender:F
Credentials:SOCIAL WORKER II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5230
Mailing Address - Country:US
Mailing Address - Phone:909-486-4077
Mailing Address - Fax:909-889-2001
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-486-4077
Practice Address - Fax:909-889-2001
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X, 104100000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health