Provider Demographics
NPI:1699410225
Name:ALVAREZ SANANGO, JESSICA F
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:F
Last Name:ALVAREZ SANANGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 92ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5862
Mailing Address - Country:US
Mailing Address - Phone:347-965-8420
Mailing Address - Fax:
Practice Address - Street 1:7125 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2014
Practice Address - Country:US
Practice Address - Phone:718-261-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114957104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker