Provider Demographics
NPI:1033401237
Name:IRBY, CHERISE (PSYD)
Entity Type:Individual
Prefix:MS
First Name:CHERISE
Middle Name:
Last Name:IRBY
Suffix:
Gender:F
Credentials:PSYD
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 588500
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8500
Mailing Address - Country:US
Mailing Address - Phone:916-395-3552
Mailing Address - Fax:
Practice Address - Street 1:8260 LONGLEAF DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-1322
Practice Address - Country:US
Practice Address - Phone:916-691-6930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33083103TC0700X
CAA8880213101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical