MEDICARE: MR. CHRISTOPHER MICHAEL LEZON MSW, ASW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	15629	CA

General Provider Information

NPI Number	:	1417976424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER MICHAEL LEZON MSW, ASW

Provider Business Mailing Address
First Line	:	4612 ROSEVILLE RD STE 107
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5175
Country	:	US
Telephone Number	:	916-344-0199
Fax Number	:

Provider Business Practice Location Address
First Line	:	4612 ROSEVILLE RD
Second Line	:	SUITE 107
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5175
Country	:	US
Telephone Number	:	916-344-0199
Fax Number	:	916-344-0196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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