Provider Demographics
NPI:1841207495
Name:CRESPO, ALFREDO E (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:E
Last Name:CRESPO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12725 VENTURA BLVD
Mailing Address - Street 2:SUITE K
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604
Mailing Address - Country:US
Mailing Address - Phone:818-506-1348
Mailing Address - Fax:818-998-2726
Practice Address - Street 1:12725 VENTURA BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604
Practice Address - Country:US
Practice Address - Phone:818-506-1348
Practice Address - Fax:818-998-2726
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical