Provider Demographics
NPI:1124641725
Name:PATRICE A. ALVARADO, PHD LLC
Entity type:Organization
Organization Name:PATRICE A. ALVARADO, PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:571-248-2145
Mailing Address - Street 1:9061 RIBBON FALLS LOOP
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-6132
Mailing Address - Country:US
Mailing Address - Phone:703-470-3875
Mailing Address - Fax:
Practice Address - Street 1:9246B MOSBY ST
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5038
Practice Address - Country:US
Practice Address - Phone:571-248-2145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty