| Mario H Irigoyen Lcsw - Llc | |
|
61 Grand Ave Englewood NJ 07631-3572 | |
| (914) 671-3924 | |
| (845) 942-1894 |
| Full Name | Mario H Irigoyen Lcsw - Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 61 Grand Ave, Englewood, New Jersey |
| Authorized Official Name and Position | Mario H Irigoyen (SOLE MBR) |
| Authorized Official Contact | 9146713924 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mario H Irigoyen Lcsw - Llc 76 Thiells Rd Stony Point NY 10980-3420 Ph: (914) 671-3924 | Mario H Irigoyen Lcsw - Llc 61 Grand Ave Englewood NJ 07631-3572 Ph: (914) 671-3924 |
| NPI Number | 1831470723 |
|---|---|
| Provider Enumeration Date | 09/06/2011 |
| Last Update Date | 09/06/2011 |
| Medicare PECOS PAC ID | 3577734920 |
|---|---|
| Medicare Enrollment ID | O20110915000702 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831470723 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 44SC05377600 (New Jersey) | Primary |
| Provider Name | Mario H Irigoyen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952607608 PECOS PAC ID: 3971780818 Enrollment ID: I20110602000272 |
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