Provider Demographics
NPI:1174944912
Name:D'ALESSANDRO, JOHN MICHAEL (MFT INTERN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:D'ALESSANDRO
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21250 BOX SPRINGS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-8705
Mailing Address - Country:US
Mailing Address - Phone:951-369-8036
Mailing Address - Fax:
Practice Address - Street 1:5080 SUNDANCE DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-2990
Practice Address - Country:US
Practice Address - Phone:909-222-9862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist