Healthcare Provider Details

I. General information

NPI: 1225260854
Provider Name (Legal Business Name): CLARA J. PELLIZZARI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2009
Last Update Date: 05/19/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E KINGS CANYON RD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

16828 N. COUNTY ROAD 1200
SHALLOWATER TX
79416-2136
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-5199
  • Fax:
Mailing address:
  • Phone: 559-260-7089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: