Provider Demographics
NPI:1235684903
Name:ALVAREZ, IDOLIDIA (LMHC)
Entity Type:Individual
Prefix:
First Name:IDOLIDIA
Middle Name:
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 1:1901 NW 82ND TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3522
Mailing Address - Country:US
Mailing Address - Phone:786-262-8713
Mailing Address - Fax:
Practice Address - Street 1:10662 NW 87TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4605
Practice Address - Country:US
Practice Address - Phone:786-262-8713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13905101YM0800X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-21-51788OtherBACB
FL022205900Medicaid
FLMH13905OtherDEPARTMENT OF HEALTH LICENSE