Provider Demographics
NPI:1063968691
Name:PIZZARDI, VIRGINIA M (MS)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:M
Last Name:PIZZARDI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:M
Other - Last Name:PIZZARDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:4155 24TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114
Mailing Address - Country:US
Mailing Address - Phone:415-285-4061
Mailing Address - Fax:
Practice Address - Street 1:4155 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3614
Practice Address - Country:US
Practice Address - Phone:415-285-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT21756101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health