Provider Demographics
NPI:1851766141
Name:AMETRANO, IRENE MASS (EDD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:MASS
Last Name:AMETRANO
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 MONTCLAIR PL
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4342
Mailing Address - Country:US
Mailing Address - Phone:734-355-6939
Mailing Address - Fax:
Practice Address - Street 1:1550 N MILFORD RD STE 101B
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1058
Practice Address - Country:US
Practice Address - Phone:734-355-6939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional