Provider Demographics
NPI:1265688907
Name:ALVAREZ, SUSANA MIDDLETON (LCSW)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:MIDDLETON
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:
Other - Last Name:MIDDLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3532 EBOE ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-2163
Mailing Address - Country:US
Mailing Address - Phone:562-822-6767
Mailing Address - Fax:
Practice Address - Street 1:3532 EBOE ST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-2163
Practice Address - Country:US
Practice Address - Phone:562-822-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA756091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical