Provider Demographics
NPI:1992417075
Name:KIRBY EDON, SONYA (LBSW)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:KIRBY EDON
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 PARK HEIGHTS AVE APT C2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3673
Mailing Address - Country:US
Mailing Address - Phone:410-925-7160
Mailing Address - Fax:
Practice Address - Street 1:6007 PARK HEIGHTS AVE APT C2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3673
Practice Address - Country:US
Practice Address - Phone:410-925-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA04855104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker