Provider Demographics
NPI:1801418124
Name:ALICIA DANFORTH, PH.D., A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:ALICIA DANFORTH, PH.D., A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DANFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-634-9080
Mailing Address - Street 1:5610 SCOTTS VALLEY DR
Mailing Address - Street 2:STE B #285
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3465
Mailing Address - Country:US
Mailing Address - Phone:408-634-9080
Mailing Address - Fax:408-703-2015
Practice Address - Street 1:212 SANDRAYA HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3227
Practice Address - Country:US
Practice Address - Phone:408-634-9080
Practice Address - Fax:408-703-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty