Provider Demographics
NPI:1154677565
Name:ALVAREZ, IRIS JOANNE (BA, BCABA)
Entity type:Individual
Prefix:MISS
First Name:IRIS
Middle Name:JOANNE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:BA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15643 SHERMAN WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4174
Mailing Address - Country:US
Mailing Address - Phone:818-232-7940
Mailing Address - Fax:818-782-9985
Practice Address - Street 1:5554 RESEDA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6212
Practice Address - Country:US
Practice Address - Phone:818-705-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-11-4117103K00000X
CA1-14-16232103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-14-16232OtherBCBA CERTIFICATE NUMBER