Healthcare Provider Details

I. General information

NPI: 1235225764
Provider Name (Legal Business Name): ALEXA HILARY WASSERMAN-TONCHEFF PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXA HILARY WASSERMAN PSY.D.

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3128 WILLOW SUITE 102
CLOVIS CA
93612
US

IV. Provider business mailing address

3128 WILLOW SUITE 102
CLOVIS CA
93612
US

V. Phone/Fax

Practice location:
  • Phone: 559-307-5814
  • Fax:
Mailing address:
  • Phone: 559-307-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY18754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: