Provider Demographics
NPI:1609040542
Name:VASCONEZ, IRWINE E SR
Entity Type:Individual
Prefix:
First Name:IRWINE
Middle Name:E
Last Name:VASCONEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-5497
Mailing Address - Country:US
Mailing Address - Phone:610-435-5334
Mailing Address - Fax:610-351-2292
Practice Address - Street 1:462 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-5497
Practice Address - Country:US
Practice Address - Phone:610-435-5334
Practice Address - Fax:610-351-2292
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health