Provider Demographics
NPI:1982673802
Name:RALPH, ALAN S (PHD NYS LIC #:1570)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:S
Last Name:RALPH
Suffix:
Gender:M
Credentials:PHD NYS LIC #:1570
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SOUTH END AVE
Mailing Address - Street 2:#735
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1044
Mailing Address - Country:US
Mailing Address - Phone:212-619-2365
Mailing Address - Fax:212-619-2365
Practice Address - Street 1:21 SOUTH END AVE
Practice Address - Street 2:#735
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10280-1044
Practice Address - Country:US
Practice Address - Phone:212-619-2365
Practice Address - Fax:212-619-2365
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15708103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral