Provider Demographics
NPI:1952145310
Name:ALVAREZ RODRIGUEZ, MASSIEL
Entity type:Individual
Prefix:
First Name:MASSIEL
Middle Name:
Last Name:ALVAREZ RODRIGUEZ
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 1:1754 W 59TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7906
Mailing Address - Country:US
Mailing Address - Phone:305-613-7608
Mailing Address - Fax:
Practice Address - Street 1:1754 W 59TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7906
Practice Address - Country:US
Practice Address - Phone:305-613-7608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-340801106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA416-540-96-554-0OtherDL