Provider Demographics
NPI:1114266939
Name:KIRKWOOD, STEPHANIE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:KIRKWOOD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:GRECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:320 MACDADE BLVD STE NO205
Mailing Address - Street 2:
Mailing Address - City:COLLINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1927
Mailing Address - Country:US
Mailing Address - Phone:610-522-4506
Mailing Address - Fax:
Practice Address - Street 1:320 MACDADE BLVD STE NO205
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-1927
Practice Address - Country:US
Practice Address - Phone:610-522-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1114266939Medicaid