Provider Demographics
NPI:1295873644
Name:ABOULAFIA, MICHAEL ROSS (MA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROSS
Last Name:ABOULAFIA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85327-0426
Mailing Address - Country:US
Mailing Address - Phone:480-437-3014
Mailing Address - Fax:
Practice Address - Street 1:33606 N 60TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-5243
Practice Address - Country:US
Practice Address - Phone:480-575-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ121501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist