Provider Demographics
NPI:1457854440
Name:JACKSON, DORYE EMORY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DORYE
Middle Name:EMORY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DORYE
Other - Middle Name:MICHELLE
Other - Last Name:EMORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:458 WIRE MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903
Mailing Address - Country:US
Mailing Address - Phone:203-979-3503
Mailing Address - Fax:
Practice Address - Street 1:50 WASHINGTON STREET
Practice Address - Street 2:SUITE 750
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854
Practice Address - Country:US
Practice Address - Phone:203-979-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008194103TC1900X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist