Provider Demographics
NPI:1124122833
Name:IRBY, DEBRA MONTGOMERY (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MONTGOMERY
Last Name:IRBY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:IRBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:PO BOX 6562
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20916-6562
Mailing Address - Country:US
Mailing Address - Phone:202-957-9148
Mailing Address - Fax:301-262-3909
Practice Address - Street 1:6000 LAUREL BOWIE RD
Practice Address - Street 2:209D
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4000
Practice Address - Country:US
Practice Address - Phone:301-262-5203
Practice Address - Fax:301-262-3909
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD059311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD492152Medicare PIN