Provider Demographics
NPI:1184742702
Name:CHALFEN, SALLY HILTON (PHD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:HILTON
Last Name:CHALFEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:HILTON-CHALFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:703 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5032
Mailing Address - Country:US
Mailing Address - Phone:303-554-5823
Mailing Address - Fax:303-554-5823
Practice Address - Street 1:703 WALNUT ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5032
Practice Address - Country:US
Practice Address - Phone:303-554-5823
Practice Address - Fax:303-554-5823
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical