Provider Demographics
NPI:1669878641
Name:IRVINE, JAMIE (BCABA)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:IRVINE
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N BELCHER RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1339
Mailing Address - Country:US
Mailing Address - Phone:727-799-3330
Mailing Address - Fax:727-799-4632
Practice Address - Street 1:1501 N BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1339
Practice Address - Country:US
Practice Address - Phone:727-799-3330
Practice Address - Fax:727-799-4632
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-13-5611103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst