Provider Demographics
NPI:1942407697
Name:IRVING, ALLEN (MSW)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:
Last Name:IRVING
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 CARLETON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1713
Mailing Address - Country:US
Mailing Address - Phone:314-973-7601
Mailing Address - Fax:
Practice Address - Street 1:7350 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-1713
Practice Address - Country:US
Practice Address - Phone:314-973-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW 004145104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker