Provider Demographics
NPI:1508308081
Name:GONZALEZ-DAVILA, ALVARO D
Entity Type:Individual
Prefix:MR
First Name:ALVARO
Middle Name:D
Last Name:GONZALEZ-DAVILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 PHELPS LANE
Mailing Address - Street 2:DIVISION OF DRUG & ALCOHOL SERVICES
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-4005
Mailing Address - Country:US
Mailing Address - Phone:631-422-7676
Mailing Address - Fax:631-422-7609
Practice Address - Street 1:281 PHELPS LANE
Practice Address - Street 2:DIVISION OF DRUG & ALCOHOL SERVICES
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-4005
Practice Address - Country:US
Practice Address - Phone:631-422-7676
Practice Address - Fax:631-422-7609
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32337101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)