Provider Demographics
NPI:1740496082
Name:ALVAREZ, IVAN ENRIQUE (PHD)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:ENRIQUE
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB BUENA VISTA
Mailing Address - Street 2:CALLE CALMA #1228
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731
Mailing Address - Country:US
Mailing Address - Phone:787-649-2666
Mailing Address - Fax:787-259-3998
Practice Address - Street 1:URB BUENA VISTA
Practice Address - Street 2:CALLE CALMA #1228
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-649-2666
Practice Address - Fax:787-259-3998
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR794103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical