Provider Demographics
NPI:1649936568
Name:ALVARADO, JUDITH PATRICIA (IAHC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:PATRICIA
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:IAHC
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:PATRICIA
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BACHELOR DEGREE IN S
Mailing Address - Street 1:51 PLEASANT ST. FLOOR 1
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010
Mailing Address - Country:US
Mailing Address - Phone:860-790-4362
Mailing Address - Fax:
Practice Address - Street 1:51 PLEASANT ST. FLOOR 1 (VIRTUAL SERVICE)
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-790-4362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171M00000X, 172V00000X
NY1AHC967180174H00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator