Provider Demographics
NPI:1417240698
Name:BEREZAY, ALISSA CHEYENNE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:CHEYENNE
Last Name:BEREZAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 STODDARD RD STE 600
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9041
Mailing Address - Country:US
Mailing Address - Phone:209-543-1874
Mailing Address - Fax:209-543-1869
Practice Address - Street 1:5815 STODDARD RD STE 600
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9041
Practice Address - Country:US
Practice Address - Phone:209-543-1874
Practice Address - Fax:209-543-1869
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT93577106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist