Healthcare Provider Details

I. General information

NPI: 1740446384
Provider Name (Legal Business Name): BRIAN ALVARADO MHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

796H DREW ST
BROOKLYN NY
11208-4704
US

IV. Provider business mailing address

927 E 32ND ST
BROOKLYN NY
11210-3937
US

V. Phone/Fax

Practice location:
  • Phone: 718-235-3100
  • Fax: 718-277-0822
Mailing address:
  • Phone: 917-952-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000752-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: