Provider Demographics
NPI:1073771374
Name:ALVAREZ, SARA INES (LMHC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:INES
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 NW TREEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1065
Mailing Address - Country:US
Mailing Address - Phone:305-484-2219
Mailing Address - Fax:772-807-8203
Practice Address - Street 1:499 NW PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-8786
Practice Address - Country:US
Practice Address - Phone:305-484-2219
Practice Address - Fax:772-807-8203
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ146ROtherBCBS