Provider Demographics
NPI:1609326859
Name:ALFARO, AMY (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ALFARO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BUSTAMANTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3427 4TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4910
Mailing Address - Country:US
Mailing Address - Phone:619-525-9903
Mailing Address - Fax:619-525-9908
Practice Address - Street 1:3427 4TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4910
Practice Address - Country:US
Practice Address - Phone:619-525-9903
Practice Address - Fax:619-525-9908
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72874101YM0800X
CA934301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health