Provider Demographics
NPI:1356674758
Name:KORTE, ALVIN O (PHD, LISW)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:O
Last Name:KORTE
Suffix:
Gender:M
Credentials:PHD, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 DALBEY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4908
Mailing Address - Country:US
Mailing Address - Phone:505-425-3198
Mailing Address - Fax:
Practice Address - Street 1:1216 9TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4055
Practice Address - Country:US
Practice Address - Phone:505-425-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-1452104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker