Healthcare Provider Details

I. General information

NPI: 1871044594
Provider Name (Legal Business Name): IRIS DEYOUNG L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRIS RAY REGIER

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

IV. Provider business mailing address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-5174
  • Fax: 559-448-4270
Mailing address:
  • Phone: 559-448-5174
  • Fax: 559-448-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW64810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: