Provider Demographics
NPI:1699587832
Name:ALVAREZ, VICTORIA JESSICA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JESSICA
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6834 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-1962
Mailing Address - Country:US
Mailing Address - Phone:219-256-0404
Mailing Address - Fax:
Practice Address - Street 1:10419 CALUMET AVE UNIT B
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4059
Practice Address - Country:US
Practice Address - Phone:219-491-1759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician