Provider Demographics
NPI:1104091289
Name:IRONS, JOEL ROBERT
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ROBERT
Last Name:IRONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 CHANTICLEER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-3130
Mailing Address - Country:US
Mailing Address - Phone:831-454-8691
Mailing Address - Fax:
Practice Address - Street 1:125 RIGG ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4203
Practice Address - Country:US
Practice Address - Phone:831-423-3890
Practice Address - Fax:831-423-6657
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARW1508OtherCAADAC
CAB8068700OtherDRIVER LICENSE