Provider Demographics
NPI:1437287992
Name:IVASKA, IRENE GINTARE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:GINTARE
Last Name:IVASKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1617
Mailing Address - Country:US
Mailing Address - Phone:203-366-5438
Mailing Address - Fax:203-366-1580
Practice Address - Street 1:2370 PARK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1617
Practice Address - Country:US
Practice Address - Phone:203-366-5438
Practice Address - Fax:203-366-1580
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0044761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical