Healthcare Provider Details

I. General information

NPI: 1437361110
Provider Name (Legal Business Name): HEATHER KRISHNA ALVAREZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GROVEVILLE ROAD SEBAGO EDUCATIONAL ALLIANCE
BUXTON ME
04093
US

IV. Provider business mailing address

24 GROVEVILLE ROAD SEBAGO EDUCATIONAL ALLIANCE
BUXTON ME
04093
US

V. Phone/Fax

Practice location:
  • Phone: 207-727-9100
  • Fax:
Mailing address:
  • Phone: 207-727-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS1245
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: