Provider Demographics
NPI:1588317796
Name:RABINOWITZ, JACLYN
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:RABINOWITZ
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 1:5780 MELROSE AVENUE
Mailing Address - Street 2:UNIT 3640
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038
Mailing Address - Country:US
Mailing Address - Phone:323-327-3327
Mailing Address - Fax:
Practice Address - Street 1:5780 MELROSE AVENUE
Practice Address - Street 2:UNIT 3640
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038
Practice Address - Country:US
Practice Address - Phone:323-327-3327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist