Healthcare Provider Details

I. General information

NPI: 1063364792
Provider Name (Legal Business Name): ALVARO SOARES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RANDALL ST
PROVIDENCE RI
02904-2723
US

IV. Provider business mailing address

PO BOX 1700
WOONSOCKET RI
02895-0856
US

V. Phone/Fax

Practice location:
  • Phone: 401-235-7000
  • Fax: 401-767-9177
Mailing address:
  • Phone: 401-235-7000
  • Fax: 401-767-9177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP01085
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: