Healthcare Provider Details

I. General information

NPI: 1720189871
Provider Name (Legal Business Name): DANA R IRWIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CALDWELL DRIVE CLEARFIELD JEFFERSON CMHC INC
DU BOIS PA
15801
US

IV. Provider business mailing address

100 CALDWELL DRIVE
DU BOIS PA
15801
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-1100
  • Fax: 814-375-0120
Mailing address:
  • Phone: 814-371-1100
  • Fax: 814-375-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS007443L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: