Provider Demographics
NPI:1710192745
Name:STRUIF, IRENE A (IMH)
Entity Type:Individual
Prefix:MISS
First Name:IRENE
Middle Name:A
Last Name:STRUIF
Suffix:
Gender:F
Credentials:IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 LEEWAY CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4515
Mailing Address - Country:US
Mailing Address - Phone:407-622-7608
Mailing Address - Fax:407-622-7608
Practice Address - Street 1:499 N STATE ROAD 434
Practice Address - Street 2:SUITE 2007
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2142
Practice Address - Country:US
Practice Address - Phone:407-291-8009
Practice Address - Fax:407-291-9620
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health