Provider Demographics
NPI:1992756175
Name:STUDWELL, IRENE E (LCSW)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:E
Last Name:STUDWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SETON WAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-4715
Mailing Address - Country:US
Mailing Address - Phone:914-761-6886
Mailing Address - Fax:914-761-6886
Practice Address - Street 1:2 SETON WAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-4715
Practice Address - Country:US
Practice Address - Phone:914-761-6886
Practice Address - Fax:914-761-6886
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0703811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070381OtherPROVIDER LICENSE #
NY1285628552OtherJDAM NPI #
NY00355940Medicaid
NYWVE061Medicare ID - Type UnspecifiedJDAM MEDICARE PROVIDER #
NY1285628552OtherJDAM NPI #