Provider Demographics
NPI:1063722783
Name:WILLIAM A KIRBY PSYCHOLOGIST, PC
Entity type:Organization
Organization Name:WILLIAM A KIRBY PSYCHOLOGIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-742-6530
Mailing Address - Street 1:7 WARTON PLACE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3050
Mailing Address - Country:US
Mailing Address - Phone:516-742-6530
Mailing Address - Fax:516-747-3647
Practice Address - Street 1:7 WARTON PLACE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3050
Practice Address - Country:US
Practice Address - Phone:516-742-6530
Practice Address - Fax:516-747-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010204103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1124041678OtherNPI - ENTITY