Provider Demographics
NPI:1528390549
Name:ALAFIA MENTAL HEALTH
Entity Type:Organization
Organization Name:ALAFIA MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRITH
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:909-386-0335
Mailing Address - Street 1:1802 COMMERCENTER W STE B
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3301
Mailing Address - Country:US
Mailing Address - Phone:909-386-0335
Mailing Address - Fax:
Practice Address - Street 1:1802 COMMERCENTER W STE B
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3301
Practice Address - Country:US
Practice Address - Phone:909-386-0335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30166251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health