Provider Demographics
NPI:1093493256
Name:ALFANO, ERICA LEE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEE
Last Name:ALFANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1757
Mailing Address - Country:US
Mailing Address - Phone:913-709-6442
Mailing Address - Fax:
Practice Address - Street 1:110 S CHERRY ST STE 202
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3441
Practice Address - Country:US
Practice Address - Phone:913-709-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03232-T103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical