Provider Demographics
NPI:1831470723
Name:MARIO H IRIGOYEN LCSW - LLC
Entity Type:Organization
Organization Name:MARIO H IRIGOYEN LCSW - LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:H
Authorized Official - Last Name:IRIGOYEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:914-671-3924
Mailing Address - Street 1:76 THIELLS RD
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-3420
Mailing Address - Country:US
Mailing Address - Phone:914-671-3924
Mailing Address - Fax:845-942-1894
Practice Address - Street 1:61 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3572
Practice Address - Country:US
Practice Address - Phone:914-671-3924
Practice Address - Fax:845-942-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05377600251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health