Provider Demographics
NPI:1306200118
Name:ENGEL, IRIS S (ACAS)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:S
Last Name:ENGEL
Suffix:
Gender:F
Credentials:ACAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 SIMSBURY RD
Mailing Address - Street 2:
Mailing Address - City:WEST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06090-1606
Mailing Address - Country:US
Mailing Address - Phone:860-508-6759
Mailing Address - Fax:860-831-1113
Practice Address - Street 1:199 SIMSBURY RD
Practice Address - Street 2:
Practice Address - City:WEST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06090-1606
Practice Address - Country:US
Practice Address - Phone:860-508-6759
Practice Address - Fax:860-831-1113
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst