Provider Demographics
NPI:1063183614
Name:ALVAREZ-MORENO, ILITZA (LCSW-S)
Entity type:Individual
Prefix:
First Name:ILITZA
Middle Name:
Last Name:ALVAREZ-MORENO
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 TWAIN TRL
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-7700
Mailing Address - Country:US
Mailing Address - Phone:469-496-9901
Mailing Address - Fax:
Practice Address - Street 1:141 MILITARY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39232-8877
Practice Address - Country:US
Practice Address - Phone:601-405-8418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical