Provider Demographics
NPI:1245453414
Name:BATTALIA, JACLYN JEAN (RAS-I)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:JEAN
Last Name:BATTALIA
Suffix:
Gender:F
Credentials:RAS-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 DASHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1832
Mailing Address - Country:US
Mailing Address - Phone:562-673-0258
Mailing Address - Fax:213-747-4835
Practice Address - Street 1:3130 S HILL ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3817
Practice Address - Country:US
Practice Address - Phone:213-747-7267
Practice Address - Fax:213-747-4835
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)