Provider Demographics
NPI:1326020991
Name:ALFANO, MARK STEPHEN (PHD, ABPP (CN))
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:ALFANO
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Gender:M
Credentials:PHD, ABPP (CN)
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Mailing Address - Street 1:8700 BEVERLY BLVD
Mailing Address - Street 2:ROOM 7215
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-3933
Mailing Address - Fax:310-423-4868
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:ROOM 7215
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-3933
Practice Address - Fax:310-423-4868
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY15710103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist