Provider Demographics
NPI:1235277856
Name:KIRK, BARBARA J (LCSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:KIRK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 US HIGHWAY 41 BYP S # 127
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1032
Mailing Address - Country:US
Mailing Address - Phone:503-899-3562
Mailing Address - Fax:
Practice Address - Street 1:333 TAMIAMI TRL S STE 288
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285
Practice Address - Country:US
Practice Address - Phone:941-525-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW145591041C0700X
VA09040093541041C0700X
DCLC500809391041C0700X
HILCSW 32601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical