Provider Demographics
NPI:1326068115
Name:ALFANO, KIMBERLY (PHD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ALFANO
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:PO BOX 7203
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93006-7203
Mailing Address - Country:US
Mailing Address - Phone:805-760-1209
Mailing Address - Fax:805-765-9557
Practice Address - Street 1:5266 HOLLISTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-4038
Practice Address - Country:US
Practice Address - Phone:805-760-1209
Practice Address - Fax:805-765-9557
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14650103T00000X
CA14650103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist