Provider Demographics
NPI:1407007800
Name:LACSON, GIRLYANNE BATAC
Entity Type:Individual
Prefix:
First Name:GIRLYANNE
Middle Name:BATAC
Last Name:LACSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6848 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2857
Mailing Address - Country:US
Mailing Address - Phone:951-341-8830
Mailing Address - Fax:
Practice Address - Street 1:6848 MAGNOLIA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2857
Practice Address - Country:US
Practice Address - Phone:951-341-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW27075104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker