Provider Demographics
NPI:1326452897
Name:VONETES, ALFRED DEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:DEAN
Last Name:VONETES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 MILLENIA BLVD STE 175
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6015
Mailing Address - Country:US
Mailing Address - Phone:804-920-5613
Mailing Address - Fax:866-480-9482
Practice Address - Street 1:4700 MILLENIA BLVD STE 175
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6015
Practice Address - Country:US
Practice Address - Phone:407-494-7880
Practice Address - Fax:866-480-9482
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8364348103T00000X
FLPY 8996103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY8996OtherFL STATE PROFESSIONAL LICENSE
FL8364348OtherFLORIDA STATE LICENSE