Provider Demographics
NPI:1386718062
Name:ALVAREZ, MANUEL F (PHD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:F
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TAYLOR RIDGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-8451
Mailing Address - Country:US
Mailing Address - Phone:732-513-4671
Mailing Address - Fax:904-679-5099
Practice Address - Street 1:4715 VIEWRIDGE AVENUE, SUITE 230
Practice Address - Street 2:VERICARE OF FLORIDA
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1658
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8749103T00000X
NY011200103T00000X
NJ35SI00330100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7329407Medicaid
NJ7329407Medicaid