Provider Demographics
NPI:1235389578
Name:ALVARADO, PHYLLIS A
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:A
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1329 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-3211
Mailing Address - Country:US
Mailing Address - Phone:718-337-6800
Mailing Address - Fax:718-337-0940
Practice Address - Street 1:1329 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3211
Practice Address - Country:US
Practice Address - Phone:718-337-6800
Practice Address - Fax:718-337-0940
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080188104100000X
NY0806561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker