Provider Demographics
NPI:1306094297
Name:KIRBY, CHARLES F III (LMSW-CC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:F
Last Name:KIRBY
Suffix:III
Gender:M
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAZEL TER STE 11
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2240
Mailing Address - Country:US
Mailing Address - Phone:203-819-7650
Mailing Address - Fax:203-597-8860
Practice Address - Street 1:30 HAZEL TER STE 11
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2240
Practice Address - Country:US
Practice Address - Phone:203-819-7650
Practice Address - Fax:203-298-9487
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MEMC112531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical