Provider Demographics
NPI:1962567479
Name:ROSANO-ALVAREZ, JOEL (MA, CADC1,)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:
Last Name:ROSANO-ALVAREZ
Suffix:
Gender:M
Credentials:MA, CADC1,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:
Mailing Address - City:MOUNT ANGEL
Mailing Address - State:OR
Mailing Address - Zip Code:97362-0050
Mailing Address - Country:US
Mailing Address - Phone:503-566-2901
Mailing Address - Fax:503-566-2977
Practice Address - Street 1:302 W HAYES ST
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-4616
Practice Address - Country:US
Practice Address - Phone:503-566-2901
Practice Address - Fax:503-566-2977
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORIN PROCESS101YM0800X
OR01-P-09101YA0400X
OR376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No376K00000XNursing Service Related ProvidersNurse's Aide