Provider Demographics
NPI:1336439025
Name:KAGAN, IRINA (LCSW)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:KAGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-4642
Mailing Address - Country:US
Mailing Address - Phone:972-345-1778
Mailing Address - Fax:214-820-7788
Practice Address - Street 1:108 SHANNON DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-4642
Practice Address - Country:US
Practice Address - Phone:972-345-1778
Practice Address - Fax:214-820-7788
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX358081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical