Provider Demographics
NPI:1578656013
Name:ALVAREZ, LORRAINE L (LCSW)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:L
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:LOMAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4212 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5319
Mailing Address - Country:US
Mailing Address - Phone:602-263-1200
Mailing Address - Fax:602-263-1638
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-263-1200
Practice Address - Fax:602-263-1638
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-114311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ030078Medicare Oscar/Certification
AZ8HE652Medicare ID - Type UnspecifiedPART B
AZQ55743Medicare UPIN