Provider Demographics
NPI:1073629051
Name:AMALFITANO, ROSE MARY (PHD)
Entity Type:Individual
Prefix:
First Name:ROSE MARY
Middle Name:
Last Name:AMALFITANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3327
Mailing Address - Country:US
Mailing Address - Phone:916-453-1320
Mailing Address - Fax:916-453-0572
Practice Address - Street 1:874 57TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3327
Practice Address - Country:US
Practice Address - Phone:916-453-1320
Practice Address - Fax:916-453-0572
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7906103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY7906OtherSTATE LICENSE NUMBER
CAPSY7906OtherSTATE LICENSE NUMBER