Provider Demographics
NPI:1023834124
Name:JACKSON, REBECCA SABRINA (CRPA)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SABRINA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CRPA
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:SABRINA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 KRAMER ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2549
Mailing Address - Country:US
Mailing Address - Phone:347-277-1843
Mailing Address - Fax:
Practice Address - Street 1:100 KRAMER ST APT 3E
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2549
Practice Address - Country:US
Practice Address - Phone:347-277-1843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)