Provider Demographics
NPI:1679082283
Name:PIGORSCH, ALEXIS ALEXANDRIA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:ALEXANDRIA
Last Name:PIGORSCH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-0410
Mailing Address - Country:US
Mailing Address - Phone:209-747-8389
Mailing Address - Fax:
Practice Address - Street 1:2431 W MARCH LN STE 100
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8211
Practice Address - Country:US
Practice Address - Phone:209-477-6300
Practice Address - Fax:209-541-3370
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA766001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty