Provider Demographics
NPI:1982950408
Name:ALVAREZ-VILLADA, MARTIN ALONSO (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:ALONSO
Last Name:ALVAREZ-VILLADA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 75TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1011
Mailing Address - Country:US
Mailing Address - Phone:718-505-1531
Mailing Address - Fax:347-808-9871
Practice Address - Street 1:4045 75TH ST FL 2
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1011
Practice Address - Country:US
Practice Address - Phone:718-505-1531
Practice Address - Fax:347-808-9871
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086859-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical