Provider Demographics
NPI:1720588064
Name:TOUSSAINT, IRENA
Entity Type:Individual
Prefix:
First Name:IRENA
Middle Name:
Last Name:TOUSSAINT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5152
Mailing Address - Country:US
Mailing Address - Phone:754-234-2450
Mailing Address - Fax:954-653-8625
Practice Address - Street 1:5821 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5152
Practice Address - Country:US
Practice Address - Phone:754-234-2450
Practice Address - Fax:954-653-8625
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician