Provider Demographics
NPI:1871118042
Name:ALONZO, MAYRA SAMANTHA
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:SAMANTHA
Last Name:ALONZO
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 1:2539 VILLAGE CREEK LNDG SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-3278
Mailing Address - Country:US
Mailing Address - Phone:401-481-6098
Mailing Address - Fax:
Practice Address - Street 1:2539 VILLAGE CREEK LNDG SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-3278
Practice Address - Country:US
Practice Address - Phone:401-481-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker