Provider Demographics
NPI:1699393751
Name:IRBY, CARMEN CAVIN
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:CAVIN
Last Name:IRBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6148
Mailing Address - Country:US
Mailing Address - Phone:630-581-0334
Mailing Address - Fax:
Practice Address - Street 1:740 QUAIL RIDGE DR BLDG D
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6148
Practice Address - Country:US
Practice Address - Phone:680-581-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSRBT-20-125638106S00000X
MS220103103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician