MEDICARE: MS. ALEXANDRA PEZZI CONGER LMFT

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	106H00000X	Marriage & Family Therapist	MFC 36734	CA

General Provider Information

NPI Number	:	1568686319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEXANDRA PEZZI CONGER LMFT

Provider Business Mailing Address
First Line	:	6386 EMBARCADERO DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-3826
Country	:	US
Telephone Number	:	209-601-2727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 GRAND CANAL BLVD STE C3
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-8114
Country	:	US
Telephone Number	:	209-601-2727
Fax Number	:

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	12/30/2022

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