ERIC D JACKSON (NPI# 1184047698) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184047698 |
| Entity Type | Individual |
| Full Name | ERIC D JACKSON |
| Credential | PHD |
| Practice Address |
35 Old Tavern Rd Suite 103 Orange CT 06477-3450 |
| Mailing Address |
88 E Broadway Apt B Milford CT 06460-6128 |
| Practice Telephone | 2037019666 |
| Mailing Telephone | 2037019666 |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2014-02-04 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
003329 | CT | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447728910 | Eric Jackson | Specialist/Technologist | 1219 6th Ave S, Birmingham, AL 35233 | 2018-11-02 |
| 1043725211 | Eric Jackson | Counselor | 51 Lima St, Aurora, CO 80010-4616 | 2017-12-09 |
| 1164733267 | Eric Jackson | Speech-Language Pathologist | 75 Pierrepont St Apt 3d, Brooklyn, NY 11201-2429 | 2010-06-23 |
| 1083764559 | Eric Jackson | Dentist | 9631b Fm 1960 Rd W, Houston, TX 77070-6110 | 2007-01-10 |
| 1518042233 | Eric A Jackson | Emergency Medicine | 811 Sixth Street, Suite #210, Wichita Falls, TX 76301 | 2006-10-25 |
| 1164510202 | Eric Winfred Jackson | Physical Therapist | 3662 Inwood Avenue, New Orleans, LA 70131 | 2006-10-11 |
| 1235131251 | Eric M Jackson | Internal Medicine | 16-18 Ridge Road, North Rlington, NJ 07031-6314 | 2005-08-10 |
| 1205298734 | Eric Jackson | Pediatrics | 240 E Huron St, Mcgaw Pavilion Suite 1-200, Chicago, IL 60611-2909 | 2016-03-23 |
| 1205200011 | Eric Jackson | Counselor | 770 Woodlane Rd, Westampton, NJ 08060-3804 | 2015-11-17 |
| 1235531823 | Eric T Jackson | Social Worker | 110 Hidden Valley Rd, Mc Murray, PA 15317-2685 | 2014-09-25 |
| Street Address |
35 OLD TAVERN RD SUITE 103 |
| City | ORANGE |
| State | CT |
| Zip Code | 06477-3450 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124049861 | Khaled I Mohamed | Psychiatry & Neurology | 35 Old Tavern Rd, Suite 101, Orange, CT 06477-3450 | 2006-07-21 |
| 1386175883 | Bo Acupuncture Healing, LLC | Acupuncturist | 35 Old Tavern Rd, Suite 101, Orange, CT 06477-3450 | 2017-03-26 |
| 1114475985 | Bo Fang | Acupuncturist | 35 Old Tavern Rd, Orange, CT 06477-3450 | 2016-09-21 |
| 1922552967 | Khaled Mohamed, Md LLC | Psychiatry & Neurology | 35 Old Tavern Rd, Suite 101, Orange, CT 06477-3450 | 2016-08-08 |
| 1700233921 | Chs Life Limited Liability Company | Acupuncturist | 35 Old Tavern Rd, Orange, CT 06477-3450 | 2016-05-17 |
| 1295127041 | Personal Growth & Wellness | Counselor | 35 Old Tavern Rd, Suite 101, Orange, CT 06477-3450 | 2015-03-02 |
| 1568702819 | Christiane J. Maiorana | Social Worker | 35 Old Tavern Rd, Orange, CT 06477-3450 | 2013-02-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881207207 | Kevin Cheung | Registered Nurse | 499 West Campus Drive, Orange, CT 06477 | 2020-08-25 |
| 1629539051 | Leah Kragh | Occupational Therapist | 308 Racebrook Road, Unit A, Orange, CT 06477 | 2019-03-28 |
| 1871076315 | Mario Paredes | Physical Therapist | 240 Indian River Rd Ste B7b8, Orange, CT 06477 | 2018-09-11 |
| 1790201499 | Amy Elise Roth | Speech-Language Pathologist | 308 Racebrook Road, Orange, CT 06477 | 2017-08-15 |
| 1720435092 | Eric Han | Obstetrics & Gynecology | 100 West Campus Drive, Orange, CT 06477 | 2016-05-17 |
| 1467838730 | Dr. Margaret Azzarella LLC | Chiropractor | 472 Boston Post Road, Orange, CT 06477 | 2015-08-10 |
| 1790114866 | The Eye Care Group | Eyewear Supplier (Equipment, not the service) | 250 Indian River Road, Orange, CT 06477 | 2013-11-08 |
| 1609111814 | Michael L Crane | Counselor | 426 Taulman Rd, Orange, CT 06477 | 2012-11-29 |
| 1316183726 | Sarah E Halloran | Physician Assistant | 240 Indian River Rd Ste B1, Orange, CT 06477 | 2009-01-07 |
| 1558482075 | Jasdeep Sidana | Internal Medicine | 521 Boston Post Road, Orange, CT 06477 | 2007-04-02 |
| Find all providers in zip 06477 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982203568 | Gautami Polepally Ashok | Psychologist | 1234 W Chapman Ave Ste 203, Orange, CA 92868-2863 | 2020-10-23 |
| 1740718766 | Nissa Chantana | Psychologist | 2230 W Chapman Ave Ste 232, Orange, CA 92868-2316 | 2017-06-03 |
| 1730462409 | Luke Meier | Psychologist | 148 N Mine Canyon Rd Unit E, Orange, CA 92869 | 2011-09-20 |
| 1811205222 | Robin Hong | Psychologist | 800 N Eckhoff St Bldg 124, Orange, CA 92868-1008 | 2010-09-20 |
| 1720395163 | Suangsmorn Stapatyanon | Psychologist | 301 N Rampart St, Suite E, Orange, CA 92868-1854 | 2010-09-07 |
| 1942516786 | Lindsay Deibler | Psychologist | 1110 East Chapman Ave. Suite 201, Orange, CA 92866-2139 | 2010-08-30 |
| 1982937892 | Rachael D Berg-martinez | Psychologist | 840 Town & Country Rd., Orange, CA 92868 | 2009-09-09 |
| 1700017340 | Katherine Ann Barnes | Psychologist | 1500 E Katella Ave Ste H, Orange, CA 92867 | 2009-07-30 |
| 1386889228 | Tryston Thuymai Nguyen | Psychologist | 2445 W Chapman Ave Ste 130, Orange, CA 92868-2320 | 2008-12-05 |
| 1417100744 | Judith Linnan | Psychologist | 1420 E Chapman Ave, Orange, CA 92866-2229 | 2008-10-30 |
| Find all providers in ORANGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.