Provider Demographics
NPI:1114347168
Name:ISABEL ALFONSO, PH.D., INC.
Entity Type:Organization
Organization Name:ISABEL ALFONSO, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-577-3204
Mailing Address - Street 1:1017 THOMASVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6262
Mailing Address - Country:US
Mailing Address - Phone:850-577-3204
Mailing Address - Fax:850-577-0605
Practice Address - Street 1:1017 THOMASVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6262
Practice Address - Country:US
Practice Address - Phone:850-577-3204
Practice Address - Fax:850-577-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6302103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty