Provider Demographics
NPI:1184732596
Name:ALONSO, ERIK X (PSYD, LCSW)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:X
Last Name:ALONSO
Suffix:
Gender:M
Credentials:PSYD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22056 SW 131ST PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-2659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 SEVILLA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6617
Practice Address - Country:US
Practice Address - Phone:305-774-1007
Practice Address - Fax:305-774-1009
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW81881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL757577100Medicaid