Provider Demographics
NPI:1205035722
Name:PERLINE, IRVIN HARVEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRVIN
Middle Name:HARVEY
Last Name:PERLINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1753 E BROADWAY RD
Mailing Address - Street 2:SUITE 101-406
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2081
Mailing Address - Country:US
Mailing Address - Phone:480-752-9410
Mailing Address - Fax:480-752-9410
Practice Address - Street 1:3131 E CAMELBACK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4500
Practice Address - Country:US
Practice Address - Phone:480-752-9410
Practice Address - Fax:480-752-9410
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0249103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical