Provider Demographics
NPI:1720580780
Name:IRIZARRY, DEBORAH (MSW)
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:
Last Name:IRIZARRY
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 1:4511 COVE DR APT 203
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32812-2929
Mailing Address - Country:US
Mailing Address - Phone:787-901-9704
Mailing Address - Fax:
Practice Address - Street 1:4511 COVE DR APT 203
Practice Address - Street 2:
Practice Address - City:BELLE ISLE
Practice Address - State:FL
Practice Address - Zip Code:32812-2929
Practice Address - Country:US
Practice Address - Phone:787-901-9704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR98431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty