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General NPI Number Information
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NPI Number | 1205035722
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Entity Type | Individual
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Provider Name | IRVIN HARVEY PERLINE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 3131 E CAMELBACK RD SUITE 200
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City | PHOENIX
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State | AZ
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Zip | 85016-4500
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Country | US
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Telephone | 480-752-9410
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Fax | 480-752-9410
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Provider Business Mailing Address
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Address Line | 1753 E BROADWAY RD SUITE 101-406
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City | TEMPE
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State | AZ
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Zip | 85282-2081
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Country | US
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Telephone | 480-752-9410
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Fax | 480-752-9410
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0249
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License Number State | AZ
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