Provider Demographics
NPI:1578070744
Name:DHALIWAL, JAGMEET (ASW)
Entity Type:Individual
Prefix:
First Name:JAGMEET
Middle Name:
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 E DAKOTA AVE STE Q
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4821
Mailing Address - Country:US
Mailing Address - Phone:559-385-6200
Mailing Address - Fax:
Practice Address - Street 1:1925 E DAKOTA AVE STE Q
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4821
Practice Address - Country:US
Practice Address - Phone:559-216-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87458101YM0800X
CA879461041C0700X
CA87485104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical