Provider Demographics
NPI:1407295454
Name:PASCUAL, JAMIE RODERICK (PSYCH TECH)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:RODERICK
Last Name:PASCUAL
Suffix:
Gender:M
Credentials:PSYCH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 TOBIN DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-1676
Mailing Address - Country:US
Mailing Address - Phone:707-280-5734
Mailing Address - Fax:707-648-3360
Practice Address - Street 1:815 TOBIN DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-1676
Practice Address - Country:US
Practice Address - Phone:707-280-5734
Practice Address - Fax:707-648-3360
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health