Provider Demographics
NPI:1619542578
Name:IRWIN, JAMIE ISAAC (LMSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ISAAC
Last Name:IRWIN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 KYNWYD RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3842
Mailing Address - Country:US
Mailing Address - Phone:302-507-4748
Mailing Address - Fax:
Practice Address - Street 1:900 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2280
Practice Address - Country:US
Practice Address - Phone:302-797-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136352104100000X
DEQ3-0010450104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker