Provider Demographics
NPI:1801362975
Name:ALFRED, ANITHE
Entity Type:Individual
Prefix:
First Name:ANITHE
Middle Name:
Last Name:ALFRED
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 1:8401 LAKE WORTH RD STE 212
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2400
Mailing Address - Country:US
Mailing Address - Phone:561-340-1491
Mailing Address - Fax:561-340-1497
Practice Address - Street 1:8401 LAKE WORTH RD STE 212
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2400
Practice Address - Country:US
Practice Address - Phone:561-340-1491
Practice Address - Fax:561-340-1497
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician