Provider Demographics
NPI:1306158910
Name:MCLOUGHLIN, IRENE (PSYD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MAYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1132
Mailing Address - Country:US
Mailing Address - Phone:415-835-2189
Mailing Address - Fax:
Practice Address - Street 1:104 MAYWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1132
Practice Address - Country:US
Practice Address - Phone:415-835-2189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18149103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL18149Medicare PIN