MEDICARE: MR. ISMAEL ALVAREZ JR. ED.M., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC004713	PA

General Provider Information

NPI Number	:	1912194127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ISMAEL ALVAREZ JR. ED.M., LPC

Provider Business Mailing Address
First Line	:	417 N 8TH ST FL 4
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-3916
Country	:	US
Telephone Number	:	215-496-0707
Fax Number	:	215-627-9042

Provider Business Practice Location Address
First Line	:	417 N 8TH ST FL 4
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-3916
Country	:	US
Telephone Number	:	215-496-0707
Fax Number	:	215-627-9042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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