Provider Demographics
NPI:1154951689
Name:VERA, JACQUELINE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:VERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:ALVAREZ LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7141 WOODLEY AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3932
Mailing Address - Country:US
Mailing Address - Phone:818-285-8252
Mailing Address - Fax:818-273-1831
Practice Address - Street 1:1737 ATLANTA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2442
Practice Address - Country:US
Practice Address - Phone:818-285-8252
Practice Address - Fax:818-273-1831
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1976830OtherRBT