Healthcare Provider Details

I. General information

NPI: 1134283773
Provider Name (Legal Business Name): RAPHAEL ALBERT ALFORD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E 137TH ST
BRONX NY
10454-4004
US

IV. Provider business mailing address

3030 RADCLIFF AVE
BRONX NY
10469-3916
US

V. Phone/Fax

Practice location:
  • Phone: 718-993-3458
  • Fax: 718-993-3948
Mailing address:
  • Phone: 718-798-0289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number015885-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: