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General NPI Number Information
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NPI Number | 1023150604
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Entity Type | Individual
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Provider Name | MS. MARYLYN LOUISA TESCONI
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Gender | Female
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 1735 MISSION ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-2417
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Country | US
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Telephone | 415-452-9619
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Fax |
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Provider Business Mailing Address
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Address Line | 766 CAYUGA AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94112-2508
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Country | US
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Telephone | 415-452-9619
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF 70833
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 101762
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License Number State | CA
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