Provider Demographics
NPI:1992295802
Name:ALVARADO, ELSIE JOANN (LCSW)
Entity type:Individual
Prefix:
First Name:ELSIE
Middle Name:JOANN
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 FROST RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-2154
Mailing Address - Country:US
Mailing Address - Phone:203-819-0789
Mailing Address - Fax:
Practice Address - Street 1:230 FROST RD UNIT B
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2154
Practice Address - Country:US
Practice Address - Phone:203-819-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0097061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT009706Medicaid