Provider Information for 1376058958
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JACLYN DECARLO LCSW
Sex: Female
NPI: 1376058958
Last Updated: 2022-12-19
Certification Date: 2022-12-08
Certification Date: 2022-12-08
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1376058958 | ||||||||
| Enumeration Date | 2017-12-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 651 I ST SACRAMENTO, CA 95814-2400 United States Phone: 916-874-6172 | Fax: | ||||||||
| Primary Practice Address | 651 I ST SACRAMENTO, CA 95814-2400 United States Phone: 916-874-6172 | Fax:916-874-6904 | ||||||||
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