Healthcare Provider Details

I. General information

NPI: 1780494336
Provider Name (Legal Business Name): LORENA ALVAREZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 3RD ST
IDAHO FALLS ID
83401-3953
US

IV. Provider business mailing address

560 3RD ST
IDAHO FALLS ID
83401-3953
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-0169
  • Fax: 208-542-5152
Mailing address:
  • Phone: 208-529-0169
  • Fax: 208-542-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-44168
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: