Provider Demographics
NPI:1740896331
Name:IRWIN, NAOWARAT BUDDEE (MA, R-DMT)
Entity type:Individual
Prefix:
First Name:NAOWARAT
Middle Name:BUDDEE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:MA, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 BELMONT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4434
Mailing Address - Country:US
Mailing Address - Phone:773-704-0154
Mailing Address - Fax:
Practice Address - Street 1:667 BELMONT ST APT 2
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4434
Practice Address - Country:US
Practice Address - Phone:773-704-0154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor