Provider Demographics
NPI:1790093904
Name:ALVAREZ, IVELISSE (MED)
Entity Type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 621568
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32762-1568
Mailing Address - Country:US
Mailing Address - Phone:407-901-3488
Mailing Address - Fax:
Practice Address - Street 1:5971 BRICK CT FL 2
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9307
Practice Address - Country:US
Practice Address - Phone:407-901-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH8982252Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No252Y00000XAgenciesEarly Intervention Provider Agency