Provider Demographics
NPI:1285270256
Name:AMIN, JACQUELINE YAEL
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:YAEL
Last Name:AMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 CHANDLER BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1955
Mailing Address - Country:US
Mailing Address - Phone:818-821-6012
Mailing Address - Fax:
Practice Address - Street 1:12501 CHANDLER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-1955
Practice Address - Country:US
Practice Address - Phone:818-821-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist