| Jackson Mental Health | |
|
18331 Wolfpack Way Hagerstown MD 21740-3583 | |
| (240) 405-2275 | |
| Not Available |
| Full Name | Jackson Mental Health |
|---|---|
| Speciality | Social Worker |
| Location | 18331 Wolfpack Way, Hagerstown, Maryland |
| Authorized Official Name and Position | Kathryn Jackson (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2404052275 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Mental Health 18331 Wolfpack Way Hagerstown MD 21740-3583 Ph: (240) 405-2275 | Jackson Mental Health 18331 Wolfpack Way Hagerstown MD 21740-3583 Ph: (240) 405-2275 |
| NPI Number | 1639718000 |
|---|---|
| Provider Enumeration Date | 01/02/2020 |
| Last Update Date | 02/28/2020 |
| Certification Date | 02/28/2020 |
| Medicare PECOS PAC ID | 2264860378 |
|---|---|
| Medicare Enrollment ID | O20200323002370 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639718000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kathryn C Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710478144 PECOS PAC ID: 3173951282 Enrollment ID: I20200323002485 |
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