MEDICARE: PAUL AREVALO LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	000863	CT
2	101YM0800X	Mental Health Counselor	000863	CT

General Provider Information

NPI Number	:	1093086860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL AREVALO LADC

Provider Business Mailing Address
First Line	:	13 EDMOND ST
Second Line	:
City	:	DARIEN
State	:	CT
Zip	:	06820-3111
Country	:	US
Telephone Number	:	203-219-5133
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 CRESCENT ST
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06906-1816
Country	:	US
Telephone Number	:	203-219-5133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	05/12/2026

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