Provider Demographics
NPI:1689064099
Name:ALCANTARA, ALVELY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ALVELY
Middle Name:
Last Name:ALCANTARA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SHELLY RIDGE LN APT 105
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-2858
Mailing Address - Country:US
Mailing Address - Phone:910-635-6247
Mailing Address - Fax:
Practice Address - Street 1:510 SHELLY RIDGE LN APT 105
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-2858
Practice Address - Country:US
Practice Address - Phone:910-635-6247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP009328104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker