Provider Demographics
NPI:1912194127
Name:ALVAREZ, ISMAEL JR (EDM, LPC)
Entity Type:Individual
Prefix:MR
First Name:ISMAEL
Middle Name:
Last Name:ALVAREZ
Suffix:JR
Gender:M
Credentials:EDM, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N 8TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3916
Mailing Address - Country:US
Mailing Address - Phone:215-496-0707
Mailing Address - Fax:215-627-9042
Practice Address - Street 1:417 N 8TH ST FL 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3916
Practice Address - Country:US
Practice Address - Phone:215-496-0707
Practice Address - Fax:215-627-9042
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional