Provider Demographics
NPI:1538353230
Name:IRWIN, THOMAS L JR (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:IRWIN
Suffix:JR
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PEACH TREE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3101
Mailing Address - Country:US
Mailing Address - Phone:314-359-1027
Mailing Address - Fax:
Practice Address - Street 1:462 N TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1831
Practice Address - Country:US
Practice Address - Phone:314-531-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0001941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493427967Medicaid