Provider Demographics
NPI:1609331362
Name:ALVAREZ, SUSANA MARIA (MS)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:MARIA
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 SW 136TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3723
Mailing Address - Country:US
Mailing Address - Phone:786-484-6216
Mailing Address - Fax:
Practice Address - Street 1:10447 SW 108TH AVE APT E278
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8115
Practice Address - Country:US
Practice Address - Phone:786-645-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst