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 1:8625 GOLF COURSE RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5114
Mailing Address - Country:US
Mailing Address - Phone:505-450-5500
Mailing Address - Fax:889-896-8728
Practice Address - Street 1:8625 GOLF COURSE RD NW STE B2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5114
Practice Address - Country:US
Practice Address - Phone:505-508-0808
Practice Address - Fax:888-896-8728
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0100131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM05959519Medicaid