Provider Demographics
NPI:1992916571
Name:ALFANO, MARCELO JOSEPH (PSYD)
Entity type:Individual
Prefix:
First Name:MARCELO
Middle Name:JOSEPH
Last Name:ALFANO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ALMERIA AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5822
Mailing Address - Country:US
Mailing Address - Phone:305-461-4702
Mailing Address - Fax:305-461-4705
Practice Address - Street 1:301 ALMERIA AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5822
Practice Address - Country:US
Practice Address - Phone:305-461-4702
Practice Address - Fax:305-461-4705
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6642103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0743Medicare ID - Type UnspecifiedPROVIDER