Provider Demographics
NPI:1053818690
Name:TRAVERSI-IRWIN, LORYN
Entity Type:Individual
Prefix:
First Name:LORYN
Middle Name:
Last Name:TRAVERSI-IRWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORYN
Other - Middle Name:
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:15 PLACID BAY DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7119
Mailing Address - Country:US
Mailing Address - Phone:978-697-7730
Mailing Address - Fax:
Practice Address - Street 1:100 ARMSTRONG RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7219
Practice Address - Country:US
Practice Address - Phone:508-209-4438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1204701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical