Provider Demographics
NPI:1013998806
Name:HUMBACH, IRENE (LCSW PC)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:HUMBACH
Suffix:
Gender:F
Credentials:LCSW PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WOODWARD RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5121
Mailing Address - Country:US
Mailing Address - Phone:845-485-5933
Mailing Address - Fax:845-485-5933
Practice Address - Street 1:11 WOODWARD RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-5121
Practice Address - Country:US
Practice Address - Phone:845-485-5933
Practice Address - Fax:845-485-5933
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028266 11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5778711OtherAETNA
NYP807741OtherOXFORD
NY7403799OtherGHI
NY7403799OtherGHI