Provider Demographics
NPI:1295192755
Name:BECERRIL, JAIME AREVALO (ACSW)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:AREVALO
Last Name:BECERRIL
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:BECERRIL
Other - Last Name:AREVALO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACSW
Mailing Address - Street 1:PO BOX 1565
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-1565
Mailing Address - Country:US
Mailing Address - Phone:909-989-5699
Mailing Address - Fax:
Practice Address - Street 1:16360 ROSCOE BLVD FL 2NF
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1219
Practice Address - Country:US
Practice Address - Phone:818-901-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW604161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical