Provider Demographics
NPI:1043318447
Name:ALVAREZ, ALFONSO (LICSW)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 NEPONSET ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1940
Mailing Address - Country:US
Mailing Address - Phone:781-828-1222
Mailing Address - Fax:781-828-5454
Practice Address - Street 1:345 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1940
Practice Address - Country:US
Practice Address - Phone:781-828-1222
Practice Address - Fax:781-828-5454
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1119471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23742Medicare ID - Type Unspecified