Provider Demographics
NPI:1134282395
Name:KIRWAN, WILLIAM TRAVERS (PHD DMIN LCPC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TRAVERS
Last Name:KIRWAN
Suffix:
Gender:M
Credentials:PHD DMIN LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 PENINSULA FARM ROAD
Mailing Address - Street 2:STE I
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012
Mailing Address - Country:US
Mailing Address - Phone:410-315-8253
Mailing Address - Fax:410-315-8256
Practice Address - Street 1:277 PENINSULA FARM ROAD
Practice Address - Street 2:STE I BAYSHORE COUNSELING & PSYCHOLOGICAL SERVICES LLC
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012
Practice Address - Country:US
Practice Address - Phone:410-315-8253
Practice Address - Fax:410-315-8256
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
60581501OtherBCBS OF MD