Provider Demographics
NPI:1194268953
Name:IRIZARRY, IVAN EMMANUEL III (MA, NCC)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:EMMANUEL
Last Name:IRIZARRY
Suffix:III
Gender:M
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5648 FRIENDSHIP AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3610
Mailing Address - Country:US
Mailing Address - Phone:530-204-7149
Mailing Address - Fax:
Practice Address - Street 1:5648 FRIENDSHIP AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3610
Practice Address - Country:US
Practice Address - Phone:530-204-7149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health