Provider Demographics
NPI:1104307511
Name:KIRBY, KRISTIN (LICSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 VIRGINIA RD
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-2346
Mailing Address - Country:US
Mailing Address - Phone:978-502-8104
Mailing Address - Fax:
Practice Address - Street 1:149 ENNELL ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850-1841
Practice Address - Country:US
Practice Address - Phone:978-937-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool