Healthcare Provider Details

I. General information

NPI: 1104967397
Provider Name (Legal Business Name): MARGARITA ALTAGRACIA ALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 CHURCH ST
WATERBURY CT
06702-2103
US

IV. Provider business mailing address

44 LINWOOD ST
WATERBURY CT
06704-2217
US

V. Phone/Fax

Practice location:
  • Phone: 203-755-1196
  • Fax:
Mailing address:
  • Phone: 203-754-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: