Provider Demographics
NPI:1376738252
Name:HAWKINS, IRMA (PHD PSYCHOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 CARROLL CANAL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4683
Mailing Address - Country:US
Mailing Address - Phone:310-822-4125
Mailing Address - Fax:310-578-2343
Practice Address - Street 1:419 CARROLL CANAL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291
Practice Address - Country:US
Practice Address - Phone:310-822-4125
Practice Address - Fax:310-578-2343
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11748103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist