Provider Demographics
NPI:1215251400
Name:KIRLEW, NICOLE JEANNE (MSW, LMSW)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JEANNE
Last Name:KIRLEW
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:JEANNE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3603 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3638
Mailing Address - Country:US
Mailing Address - Phone:480-338-8112
Mailing Address - Fax:602-445-9168
Practice Address - Street 1:3603 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3638
Practice Address - Country:US
Practice Address - Phone:480-338-8112
Practice Address - Fax:602-445-9168
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker