Provider Demographics
NPI:1306106307
Name:KIRBY, LAUREN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 N KENMORE AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2406
Mailing Address - Country:US
Mailing Address - Phone:773-332-6566
Mailing Address - Fax:
Practice Address - Street 1:5250 N KENMORE AVE # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2406
Practice Address - Country:US
Practice Address - Phone:773-332-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0126101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical