Provider Demographics
NPI:1326382029
Name:BIRKBY, BENJAMIN WILLIAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:BIRKBY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 GLENRIDGE PARK PL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3450
Mailing Address - Country:US
Mailing Address - Phone:502-417-5217
Mailing Address - Fax:
Practice Address - Street 1:6500 GLENRIDGE PARK PL
Practice Address - Street 2:SUITE 3
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3450
Practice Address - Country:US
Practice Address - Phone:502-417-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1225103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent