Provider Demographics
NPI:1770818957
Name:IRVING, DANETTE SYNTHIA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DANETTE
Middle Name:SYNTHIA
Last Name:IRVING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SAINT NICHOLAS PL APT 3A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1273
Mailing Address - Country:US
Mailing Address - Phone:917-513-5075
Mailing Address - Fax:
Practice Address - Street 1:34 SAINT NICHOLAS PL APT 3A
Practice Address - Street 2:34 ST NICHOLAS PLACE APT 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-1273
Practice Address - Country:US
Practice Address - Phone:917-513-5075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker