Provider Demographics
NPI:1598228827
Name:JAYA, ALVARO W
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:W
Last Name:JAYA
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 1:6 MONTGOMERY VILLAGE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3548
Mailing Address - Country:US
Mailing Address - Phone:301-963-7222
Mailing Address - Fax:301-963-2616
Practice Address - Street 1:6 MONTGOMERY VILLAGE AVE STE 400
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3548
Practice Address - Country:US
Practice Address - Phone:301-963-7222
Practice Address - Fax:301-963-2616
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC1748101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)