Provider Demographics
NPI:1720212384
Name:ALFONSO, JANE JOLINDON
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:JOLINDON
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-6525
Mailing Address - Country:US
Mailing Address - Phone:415-602-4614
Mailing Address - Fax:
Practice Address - Street 1:107 PARMAC RD STE 4
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2298
Practice Address - Country:US
Practice Address - Phone:530-891-2850
Practice Address - Fax:530-895-6549
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAIMF57140101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health