Provider Demographics
NPI:1093592412
Name:JALIVAY, ASHLEY GABRIELLE (RBT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GABRIELLE
Last Name:JALIVAY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4073 DOVER ST
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-6460
Mailing Address - Country:US
Mailing Address - Phone:916-832-2265
Mailing Address - Fax:916-250-0557
Practice Address - Street 1:4073 DOVER ST
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-6460
Practice Address - Country:US
Practice Address - Phone:916-832-2265
Practice Address - Fax:916-250-0557
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-23-269046106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician