Healthcare Provider Details

I. General information

NPI: 1023150604
Provider Name (Legal Business Name): MS. MARYLYN LOUISA TESCONI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 MISSION ST
SAN FRANCISCO CA
94103-2417
US

IV. Provider business mailing address

766 CAYUGA AVE
SAN FRANCISCO CA
94112-2508
US

V. Phone/Fax

Practice location:
  • Phone: 415-452-9619
  • Fax:
Mailing address:
  • Phone: 415-452-9619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 70833
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number101762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: