Provider Demographics
NPI:1952013542
Name:IRIE WELLNESS
Entity Type:Organization
Organization Name:IRIE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAVINE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:484-938-8682
Mailing Address - Street 1:697 READING AVE
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1009
Mailing Address - Country:US
Mailing Address - Phone:484-938-8682
Mailing Address - Fax:610-750-5550
Practice Address - Street 1:697 READING AVE
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1009
Practice Address - Country:US
Practice Address - Phone:484-938-8682
Practice Address - Fax:610-750-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-15
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty