Provider Demographics
NPI:1104136621
Name:ALFORD, HEATHER (PSYD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ALFORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:ALFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:639 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1003
Mailing Address - Country:US
Mailing Address - Phone:610-908-9612
Mailing Address - Fax:
Practice Address - Street 1:639 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1003
Practice Address - Country:US
Practice Address - Phone:610-908-9612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB10000746103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist