Provider Demographics
NPI:1457058232
Name:ALTVATER, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:ALTVATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BALDWIN AVE UNIT 14
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1413
Mailing Address - Country:US
Mailing Address - Phone:978-204-4111
Mailing Address - Fax:
Practice Address - Street 1:227 CHELMSFORD ST STE 13C
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2305
Practice Address - Country:US
Practice Address - Phone:978-204-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health