Provider Demographics
NPI:1619789831
Name:ALVAREZ, MARISSA (LLMSW, MPH)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:U
Credentials:LLMSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1788 WEXFORD DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3297
Mailing Address - Country:US
Mailing Address - Phone:734-747-2060
Mailing Address - Fax:
Practice Address - Street 1:2601 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3820
Practice Address - Country:US
Practice Address - Phone:734-216-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511140171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical