Provider Demographics
NPI:1699709287
Name:ALTHOF, STANELY E (PHD)
Entity type:Individual
Prefix:
First Name:STANELY
Middle Name:E
Last Name:ALTHOF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N FLAGLER DR
Mailing Address - Street 2:SUITE 540
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3428
Mailing Address - Country:US
Mailing Address - Phone:561-822-5454
Mailing Address - Fax:
Practice Address - Street 1:1515 N FLAGLER DR
Practice Address - Street 2:SUITE 540
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3428
Practice Address - Country:US
Practice Address - Phone:561-822-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6913103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6155288OtherUHC
OHALCP00698Medicare PIN
OH363309OtherWELLCARE
OH642231OtherAETNA
OHALCP00699Medicare PIN
OH000000516253OtherANTHEM
OH00000025091OtherANTHEM
OH741845OtherBUCKEYE
OHP00411228OtherRAILROAD MEDICARE
OHR71830Medicare UPIN
OH000000221038OtherUNISON
OH0864588Medicaid