Provider Demographics
NPI:1467846733
Name:ALVARADO, OMAR ELIEZER (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:ELIEZER
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 54TH ST
Mailing Address - Street 2:APT.3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2644
Mailing Address - Country:US
Mailing Address - Phone:347-244-0554
Mailing Address - Fax:
Practice Address - Street 1:226 54TH ST
Practice Address - Street 2:APT.3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2644
Practice Address - Country:US
Practice Address - Phone:347-244-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0245881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist