Provider Demographics
NPI:1942763875
Name:IRVIN, BARBARA LORRAINE (LBS)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LORRAINE
Last Name:IRVIN
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-7644
Mailing Address - Country:US
Mailing Address - Phone:570-326-3805
Mailing Address - Fax:
Practice Address - Street 1:105 FAIRVIEW CT
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-9462
Practice Address - Country:US
Practice Address - Phone:570-279-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004233103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst