Healthcare Provider Details

I. General information

NPI: 1396602264
Provider Name (Legal Business Name): DESIREE ALFARO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1704
SAN JACINTO CA
92581-1704
US

IV. Provider business mailing address

PO BOX 1704
SAN JACINTO CA
92581-1704
US

V. Phone/Fax

Practice location:
  • Phone: 951-692-6071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number135968
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: