Provider Demographics
NPI:1710066394
Name:STERN, IRENE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:M
Last Name:STERN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 WESTMORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3446
Mailing Address - Country:US
Mailing Address - Phone:315-435-7761
Mailing Address - Fax:315-435-7715
Practice Address - Street 1:520 CEDAR ST
Practice Address - Street 2:OCDMH DAY TREATMENT PROGRAM FOR CHILDREN
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2302
Practice Address - Country:US
Practice Address - Phone:315-435-7761
Practice Address - Fax:315-435-7715
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012946-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical