Provider Demographics
NPI:1922392927
Name:JACKSON, JOSEPH ALLING (LICSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALLING
Last Name:JACKSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 OLD STOCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2810
Mailing Address - Country:US
Mailing Address - Phone:413-822-1288
Mailing Address - Fax:413-637-0338
Practice Address - Street 1:66 OLD STOCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2810
Practice Address - Country:US
Practice Address - Phone:413-822-1288
Practice Address - Fax:413-637-0338
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10230441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical