Provider Demographics
NPI:1477693141
Name:ALFANO, MARY FRANCES (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES
Last Name:ALFANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:F COURTNEY
Other - Last Name:ALFANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:25 40 SHORE BLVD
Mailing Address - Street 2:APT #14 O
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3949
Mailing Address - Country:US
Mailing Address - Phone:718-545-5220
Mailing Address - Fax:
Practice Address - Street 1:25 E 10TH ST
Practice Address - Street 2:SUITE 1 E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6108
Practice Address - Country:US
Practice Address - Phone:212-353-3089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000076-1103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis