Provider Demographics
NPI:1265708440
Name:ALFONSO, MARITA LEE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARITA
Middle Name:LEE
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WALL ST APT 37K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-3171
Mailing Address - Country:US
Mailing Address - Phone:917-202-2885
Mailing Address - Fax:
Practice Address - Street 1:66 BOERUM PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5705
Practice Address - Country:US
Practice Address - Phone:718-522-6011
Practice Address - Fax:718-522-1560
Is Sole Proprietor?:No
Enumeration Date:2012-04-01
Last Update Date:2024-05-21
Deactivation Date:2021-10-27
Deactivation Code:
Reactivation Date:2024-05-21
Provider Licenses
StateLicense IDTaxonomies
NY0835091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical