MEDICARE: IRIS ABREU PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	020616	NY
2	103TC0700X	Clinical Psychologist	PSO18007	PA

General Provider Information

NPI Number	:	1760711147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS ABREU PH.D.

Provider Business Mailing Address
First Line	:	1700 N BROAD ST
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-3429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 MARKET ST STE A507
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-7501
Country	:	US
Telephone Number	:	267-225-1778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	02/16/2021

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