Provider Demographics
NPI:1295457174
Name:RALES, JACLYN ELYSE (LMSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:ELYSE
Last Name:RALES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 WOODMONT AVE APT 1301
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3781
Mailing Address - Country:US
Mailing Address - Phone:240-271-3171
Mailing Address - Fax:
Practice Address - Street 1:5044 DORSEY HALL DR STE 204
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7500
Practice Address - Country:US
Practice Address - Phone:410-884-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28869104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker