Provider Demographics
NPI:1194858860
Name:BALAREZO- RUVALCABA, JACKELINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JACKELINE
Middle Name:
Last Name:BALAREZO- RUVALCABA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15766 LA FORGE ST # 155
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2334
Mailing Address - Country:US
Mailing Address - Phone:818-644-9953
Mailing Address - Fax:
Practice Address - Street 1:9341 MONTE PUESTO DR
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-1033
Practice Address - Country:US
Practice Address - Phone:818-644-9953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8177761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical