Provider Demographics
NPI:1174353486
Name:JACKSON PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:JACKSON PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEGUEZ-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:413-265-8714
Mailing Address - Street 1:PO BOX 15024
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01115-5024
Mailing Address - Country:US
Mailing Address - Phone:413-265-8714
Mailing Address - Fax:413-225-8712
Practice Address - Street 1:1500 MAIN ST.
Practice Address - Street 2:SUITE 800
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01115
Practice Address - Country:US
Practice Address - Phone:413-265-8714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty