Provider Demographics
NPI:1598186173
Name:MORENO, JALENE DONICA (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:JALENE
Middle Name:DONICA
Last Name:MORENO
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 BUSH ST
Mailing Address - Street 2:UNIT 1140
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-4863
Mailing Address - Country:US
Mailing Address - Phone:408-472-5254
Mailing Address - Fax:
Practice Address - Street 1:88 BUSH ST
Practice Address - Street 2:UNIT 1140
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-4863
Practice Address - Country:US
Practice Address - Phone:408-472-5254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-14749103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst