Provider Demographics
NPI:1245365139
Name:DOMENECH, ALVARO (LCSW)
Entity type:Individual
Prefix:
First Name:ALVARO
Middle Name:
Last Name:DOMENECH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CARMONA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1816
Mailing Address - Country:US
Mailing Address - Phone:305-274-3172
Mailing Address - Fax:305-274-4831
Practice Address - Street 1:28 CARMONA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1816
Practice Address - Country:US
Practice Address - Phone:305-302-2007
Practice Address - Fax:305-446-0256
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW49921041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical