Provider Demographics
NPI:1447263819
Name:IRELAND, EARL KENNETH JR (EDD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:KENNETH
Last Name:IRELAND
Suffix:JR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 TEAL POINT DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8394
Mailing Address - Country:US
Mailing Address - Phone:207-883-0184
Mailing Address - Fax:
Practice Address - Street 1:335 BRIGHTON AVE
Practice Address - Street 2:UNIT 201
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2362
Practice Address - Country:US
Practice Address - Phone:207-662-8660
Practice Address - Fax:207-662-8492
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEIRMM4953Medicare ID - Type UnspecifiedPSYCHOLOGIST