Provider Demographics
NPI:1144231911
Name:ALFORD, RICHARD M (PH D)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:ALFORD
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 N RIVER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8947
Mailing Address - Country:US
Mailing Address - Phone:630-718-0717
Mailing Address - Fax:630-718-0747
Practice Address - Street 1:640 N RIVER RD STE 108
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:307-180-7176
Practice Address - Fax:630-718-0747
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004637103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical