Provider Demographics
NPI:1457622177
Name:TOMY, JALEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:JALEEN
Middle Name:
Last Name:TOMY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JALEEN
Other - Middle Name:
Other - Last Name:TOMY-YURONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:200 PRAIRIE CT UNIT 2426
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95696-3276
Mailing Address - Country:US
Mailing Address - Phone:707-408-2517
Mailing Address - Fax:
Practice Address - Street 1:400 BOYD ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4522
Practice Address - Country:US
Practice Address - Phone:707-408-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical