Provider Demographics
NPI:1871788414
Name:KLACSMANN, ALLEGRA NICOLE (PHD)
Entity type:Individual
Prefix:DR
First Name:ALLEGRA
Middle Name:NICOLE
Last Name:KLACSMANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21700 COPLEY DR STE 200
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21700 COPLEY DR STE 200
Practice Address - Street 2:SUITE 200
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2219
Practice Address - Country:US
Practice Address - Phone:800-966-7306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical