Provider Demographics
NPI:1497835607
Name:FIRENZE, IRENE (MSW)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:FIRENZE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 S PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BOWDOINHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04008-5626
Mailing Address - Country:US
Mailing Address - Phone:207-737-8509
Mailing Address - Fax:
Practice Address - Street 1:158 S PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BOWDOINHAM
Practice Address - State:ME
Practice Address - Zip Code:04008-5626
Practice Address - Country:US
Practice Address - Phone:207-737-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC28561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9970Medicare ID - Type Unspecified