Healthcare Provider Details

I. General information

NPI: 1669603098
Provider Name (Legal Business Name): MARIAN JOAN KREZANOSKI ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E KINGS CANYON RD BUILDING318
FRESNO CA
93702-3604
US

IV. Provider business mailing address

1522 MORRIS AVE
CLOVIS CA
93611-1407
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-6227
  • Fax: 559-453-8944
Mailing address:
  • Phone: 559-323-6979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW25367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: