Provider Demographics
NPI:1477109403
Name:ALVAREZ, SURELY (RBT)
Entity Type:Individual
Prefix:MRS
First Name:SURELY
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 SW 142 AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4020
Mailing Address - Country:US
Mailing Address - Phone:786-261-8994
Mailing Address - Fax:305-388-7216
Practice Address - Street 1:8320 SW 142 AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4020
Practice Address - Country:US
Practice Address - Phone:786-261-8994
Practice Address - Fax:305-388-7216
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-05370106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician