Provider Demographics
NPI:1932294378
Name:IRISH, PATRICIA F (MA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:F
Last Name:IRISH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MAIN STREET
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-651-7529
Mailing Address - Fax:802-862-9158
Practice Address - Street 1:3 MAIN STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-651-7529
Practice Address - Fax:802-862-9158
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0470000683103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTIRVN2991Medicare ID - Type UnspecifiedPROVIDER NUMBER