Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Miss. Nicole Jackson

Individual provider Substance Use Disorder Rehabilitation Clinic/Center · NPI 1972977825

Miss. Nicole Jackson is a Substance Use Disorder Rehabilitation Clinic/Center in Smithtown, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2015

Practice location Address checks out

11 Route 111
Smithtown, NY 11787-3753
Phone: (631) 920-8300
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Substance Use Disorder Rehabilitation Clinic/Center (primary) Taxonomy 261QR0405X · Licence 089076 (NY)

Record details

NPI number1972977825
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 16, 2015
Last updated in NPPESNovember 16, 2015
Mailing address11 Route 111, Smithtown, NY 11787-3753

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