Provider Demographics
NPI:1740830488
Name:ALFARO, DEBORAH ELLEN
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELLEN
Last Name:ALFARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19957 SASSOON PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3861
Mailing Address - Country:US
Mailing Address - Phone:661-513-3696
Mailing Address - Fax:
Practice Address - Street 1:23822 VALENCIA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5342
Practice Address - Country:US
Practice Address - Phone:707-266-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-15
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC4674101YP2500X
CAAMFT92303106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional