Basic Information
Provider Information
NPI: 1811049299
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALVAREZ
FirstName: JOSEPHINE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ALVAREZ
OtherFirstName: JOSIE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 5
Mailing Information
Address1: 2238 E GINTER ROAD
Address2: SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12
City: TUCSON
State: AZ
PostalCode: 95706
CountryCode: US
TelephoneNumber: 5205452137
FaxNumber: 5205452120
Practice Location
Address1: 2238 E GINTER ROAD
Address2: SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12
City: TUCSON
State: AZ
PostalCode: 85706
CountryCode: US
TelephoneNumber: 5205452137
FaxNumber: 5205452120
Other Information
ProviderEnumerationDate: 01/17/2007
LastUpdateDate: 07/26/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YS0200X AZY Behavioral Health & Social Service ProvidersCounselorSchool

No ID Information.


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