Provider Demographics
NPI:1720292782
Name:PEZZANO, JULITA GLORIA (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:JULITA
Middle Name:GLORIA
Last Name:PEZZANO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MS
Other - First Name:JULITA
Other - Middle Name:GLORIA
Other - Last Name:SAXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:PO BOX 66033
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-6033
Mailing Address - Country:US
Mailing Address - Phone:505-450-5500
Mailing Address - Fax:
Practice Address - Street 1:4601 PARADISE BLVD NW
Practice Address - Street 2:SUITE 108
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114
Practice Address - Country:US
Practice Address - Phone:505-450-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0100131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional