Provider Demographics
NPI:1316924160
Name:IRISH, JEAN DARLENE (PHD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:DARLENE
Last Name:IRISH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 PARK LANE RD
Mailing Address - Street 2:SUITE A102
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2444
Mailing Address - Country:US
Mailing Address - Phone:860-354-4135
Mailing Address - Fax:860-354-4238
Practice Address - Street 1:120 PARK LANE RD
Practice Address - Street 2:SUITE A102
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2444
Practice Address - Country:US
Practice Address - Phone:860-354-4135
Practice Address - Fax:860-354-4238
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT003087103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical