Provider Demographics
NPI:1376846857
Name:FRAGOSA-ALVAREZ, JOSE O (MS-PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:O
Last Name:FRAGOSA-ALVAREZ
Suffix:
Gender:M
Credentials:MS-PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1864
Mailing Address - Country:US
Mailing Address - Phone:413-846-4300
Mailing Address - Fax:
Practice Address - Street 1:110 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1864
Practice Address - Country:US
Practice Address - Phone:413-846-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
M18463OtherBLUE CROSS / BLUE SHIELD
MA1303295 (MH)Medicaid
MA1307576 (SA)Medicaid
M18463OtherBLUE CROSS / BLUE SHIELD