Provider Demographics
NPI:1114117942
Name:ARAUZ, JORGE BOLIVAR
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:BOLIVAR
Last Name:ARAUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:BOLIVAR
Other - Last Name:ARAUZ-CEVALLOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2615 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-3103
Mailing Address - Country:US
Mailing Address - Phone:215-423-7465
Mailing Address - Fax:
Practice Address - Street 1:112 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-1510
Practice Address - Country:US
Practice Address - Phone:215-568-0860
Practice Address - Fax:215-568-0769
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor