Provider Demographics
NPI:1982076212
Name:D'ALFONSO, MARLA ELAYNA PANCIOCCO
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:ELAYNA PANCIOCCO
Last Name:D'ALFONSO
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 1:68 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-1220
Mailing Address - Country:US
Mailing Address - Phone:339-237-0290
Mailing Address - Fax:
Practice Address - Street 1:68 ERIE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-1220
Practice Address - Country:US
Practice Address - Phone:339-237-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31905235Z00000X
MA9637235Z00000X
RISP01358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist