Provider Demographics
NPI:1730649781
Name:ALVAREZ SERRANO, MARIO (LCPC, LMHC, NCC, JD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:ALVAREZ SERRANO
Suffix:
Gender:M
Credentials:LCPC, LMHC, NCC, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S MICHIGAN AVE APT 2407
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3730
Mailing Address - Country:US
Mailing Address - Phone:312-513-7771
Mailing Address - Fax:
Practice Address - Street 1:332 S MICHIGAN AVE STE 121
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4302
Practice Address - Country:US
Practice Address - Phone:312-513-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-24
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011027101YA0400X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14426840OtherCAQH PROVIDER ID