Provider Demographics
NPI:1275870875
Name:IANTAFFI, ALEX (PHD, MS, CST, LMFT)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:IANTAFFI
Suffix:
Gender:X
Credentials:PHD, MS, CST, LMFT
Other - Prefix:
Other - First Name:ALESSANDRA
Other - Middle Name:
Other - Last Name:IANTAFFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, MS, CST, LMFT
Mailing Address - Street 1:730 E 38TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-5218
Mailing Address - Country:US
Mailing Address - Phone:612-217-0584
Mailing Address - Fax:
Practice Address - Street 1:730 E 38TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-483-5726
Practice Address - Fax:855-545-4632
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist