Provider Demographics
NPI:1093317786
Name:KIRKWOOD, BRENDA L (LMSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:KIRKWOOD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 REGIS DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1424
Mailing Address - Country:US
Mailing Address - Phone:917-951-0687
Mailing Address - Fax:
Practice Address - Street 1:166 REGIS DR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1424
Practice Address - Country:US
Practice Address - Phone:917-951-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator