Provider Demographics
NPI:1225331713
Name:IRIZARRY, ROBERTO A (PHD-COUNSELING PSYC)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:A
Last Name:IRIZARRY
Suffix:
Gender:M
Credentials:PHD-COUNSELING PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 PINES EDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-1559
Mailing Address - Country:US
Mailing Address - Phone:413-586-7859
Mailing Address - Fax:
Practice Address - Street 1:66 PINES EDGE DR
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-1559
Practice Address - Country:US
Practice Address - Phone:413-586-7859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
M18463OtherBC / BS
MA1303295 (MH)Medicaid
MA1307576 (SA)Medicaid
MA1307576 (SA)Medicaid