Provider Demographics
NPI:1669905212
Name:PITCHAIMALAI, JASHLEEN S (MED, BCBA)
Entity type:Individual
Prefix:
First Name:JASHLEEN
Middle Name:S
Last Name:PITCHAIMALAI
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:JASHLEEN
Other - Middle Name:S
Other - Last Name:LAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:983 W TENNYSON RD APT 103
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-5139
Mailing Address - Country:US
Mailing Address - Phone:510-305-0918
Mailing Address - Fax:
Practice Address - Street 1:983 W TENNYSON RD APT 103
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-5139
Practice Address - Country:US
Practice Address - Phone:510-305-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
CA1-20-42478103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician