Healthcare Provider Details

I. General information

NPI: 1649936568
Provider Name (Legal Business Name): JUDITH PATRICIA ALVARADO IAHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDITH PATRICIA ALVARADO BACHELOR DEGREE IN S

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 PLEASANT ST. FLOOR 1 (VIRTUAL SERVICE)
BRISTOL CT
06010
US

IV. Provider business mailing address

51 PLEASANT ST. FLOOR 1
BRISTOL CT
06010
US

V. Phone/Fax

Practice location:
  • Phone: 860-790-4362
  • Fax:
Mailing address:
  • Phone: 860-790-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number1AHC967180
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number1AHC967180
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: