Provider Demographics
NPI:1134884273
Name:TOLLEFSEN, ALICE (RBT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:TOLLEFSEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 E 152ND ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-2510
Mailing Address - Country:US
Mailing Address - Phone:803-939-6442
Mailing Address - Fax:
Practice Address - Street 1:121 E 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7302
Practice Address - Country:US
Practice Address - Phone:212-679-4319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician