Provider Demographics
NPI:1013029362
Name:ALVAREZ, VICKY LYNN (LMSW)
Entity Type:Individual
Prefix:DR
First Name:VICKY
Middle Name:LYNN
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LMSW
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 566
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-0566
Mailing Address - Country:US
Mailing Address - Phone:810-569-0507
Mailing Address - Fax:
Practice Address - Street 1:1063 S STATE RD STE 8A
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1900
Practice Address - Country:US
Practice Address - Phone:810-771-3457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801071823104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN73590005Medicare PIN