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General NPI Number Information
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NPI Number | 1114347168
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Entity Type | Organization
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Legal Business Name | ISABEL ALFONSO, PH.D., INC.
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 1017 THOMASVILLE RD SUITE B
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6262
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Country | US
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Telephone | 850-577-3204
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Fax | 850-577-0605
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Provider Business Mailing Address
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Address Line | 1017 THOMASVILLE RD SUITE B
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6262
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Country | US
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Telephone | 850-577-3204
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Fax | 850-577-0605
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. ISABEL ALFONSO
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Credential | PH.D.
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Telephone | 850-577-3204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6302
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License Number State | FL
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