Provider Demographics
NPI:1811160369
Name:IRVIN, JOSEPH MCCALL IV
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MCCALL
Last Name:IRVIN
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-5943
Mailing Address - Country:US
Mailing Address - Phone:504-432-6130
Mailing Address - Fax:504-471-2693
Practice Address - Street 1:2012 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-5943
Practice Address - Country:US
Practice Address - Phone:504-432-6130
Practice Address - Fax:504-471-2693
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No171M00000XOther Service ProvidersCase Manager/Care Coordinator