MEDICARE: MS. GINA R. LEVERONI MFT

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	MFC33387	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000008462	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1922028810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GINA R. LEVERONI MFT

Provider Business Mailing Address
First Line	:	3800 WATT AVE STE 110
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-2622
Country	:	US
Telephone Number	:	916-344-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 WATT AVE STE 110
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-2622
Country	:	US
Telephone Number	:	916-344-0249
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	04/20/2021

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