Provider Demographics
NPI:1679638795
Name:IRVINE, JEAN STEWART (RN LCSW)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:STEWART
Last Name:IRVINE
Suffix:
Gender:F
Credentials:RN LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 APRICOT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4409
Mailing Address - Country:US
Mailing Address - Phone:949-654-7738
Mailing Address - Fax:
Practice Address - Street 1:18811 HUNTINGTON ST
Practice Address - Street 2:#200
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:949-246-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS143721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical