Provider Demographics
NPI:1740248392
Name:ALFONSO, ISABEL (PHD)
Entity type:Individual
Prefix:DR
First Name:ISABEL
Middle Name:
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 THOMASVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6294
Mailing Address - Country:US
Mailing Address - Phone:850-577-3204
Mailing Address - Fax:850-577-0605
Practice Address - Street 1:1017 THOMASVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6294
Practice Address - Country:US
Practice Address - Phone:850-577-3204
Practice Address - Fax:850-577-0605
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6302103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54637OtherBLUE CROSS AND BLUE SHIEL