Provider Demographics
NPI:1629558903
Name:CENTRAL VALLEY THERAPEUTIC ALLIANCE, INC.
Entity Type:Organization
Organization Name:CENTRAL VALLEY THERAPEUTIC ALLIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEREZAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-408-0332
Mailing Address - Street 1:201 E ORANGEBURG AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5355
Mailing Address - Country:US
Mailing Address - Phone:209-408-0332
Mailing Address - Fax:
Practice Address - Street 1:201 E ORANGEBURG AVE STE F
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5355
Practice Address - Country:US
Practice Address - Phone:209-408-0332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty