Provider Demographics
NPI:1003689654
Name:FONSECA ALVAREZ, ANABEL DE LA CARIDAD
Entity Type:Individual
Prefix:
First Name:ANABEL
Middle Name:DE LA CARIDAD
Last Name:FONSECA ALVAREZ
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 1:821 JERSEY AVE APT 3K
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1525
Mailing Address - Country:US
Mailing Address - Phone:908-446-3691
Mailing Address - Fax:
Practice Address - Street 1:821 JERSEY AVE APT 3K
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1525
Practice Address - Country:US
Practice Address - Phone:908-446-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJBACB959746106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician