Provider Demographics
NPI:1336466960
Name:IRVING, JOANNE (PHD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:IRVING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 E WEST HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4522
Mailing Address - Country:US
Mailing Address - Phone:301-983-5788
Mailing Address - Fax:
Practice Address - Street 1:4405 E WEST HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4522
Practice Address - Country:US
Practice Address - Phone:301-983-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1884103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD185512Medicare PIN