Provider Demographics
NPI:1235463969
Name:DANFORTH, ALICIA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:LYNN
Last Name:DANFORTH
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 1:16575 LOS GATOS ALMADEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3582
Mailing Address - Country:US
Mailing Address - Phone:408-634-9080
Mailing Address - Fax:408-703-2015
Practice Address - Street 1:16575 LOS GATOS ALMADEN RD STE B
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3582
Practice Address - Country:US
Practice Address - Phone:408-634-9080
Practice Address - Fax:408-703-2015
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27822103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical