MEDICARE: JAWAHAR ALVI BCBA

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	251S00000X	Community/Behavioral Health Agency		IL
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1295168300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAWAHAR ALVI BCBA

Provider Business Mailing Address
First Line	:	354 WINONA ST
Second Line	:
City	:	PARK FOREST
State	:	IL
Zip	:	60466-1520
Country	:	US
Telephone Number	:	630-921-2317
Fax Number	:

Provider Business Practice Location Address
First Line	:	354 WINONA ST
Second Line	:
City	:	PARK FOREST
State	:	IL
Zip	:	60466-1520
Country	:	US
Telephone Number	:	630-921-2317
Fax Number	:

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

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	02/04/2023

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