Provider Demographics
NPI:1235151663
Name:SHARP, IRENE F (MA)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:F
Last Name:SHARP
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:86 LAKE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5297
Mailing Address - Country:US
Mailing Address - Phone:802-865-3450
Mailing Address - Fax:802-860-5011
Practice Address - Street 1:69 JOY DR APT D5
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6123
Practice Address - Country:US
Practice Address - Phone:802-865-3450
Practice Address - Fax:802-860-5011
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000713103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010727Medicaid
VT6704573Medicaid