Provider Demographics
NPI:1891072948
Name:ALVAREZ, WACONDA JEANENE
Entity type:Individual
Prefix:
First Name:WACONDA
Middle Name:JEANENE
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 1:1515 E TROPICANA AVE STE 375
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6520
Mailing Address - Country:US
Mailing Address - Phone:702-530-9989
Mailing Address - Fax:
Practice Address - Street 1:3435 W CRAIG RD STE A
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5116
Practice Address - Country:US
Practice Address - Phone:702-675-6314
Practice Address - Fax:702-476-9697
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9094-S104100000X
NVIC-16981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker