Provider Demographics
NPI:1356451322
Name:KIRLIN, KRISTIN (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:KIRLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 E SHEA BLVD
Mailing Address - Street 2:MAYO CLINIC - PSYCHOLOGY
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5404
Mailing Address - Country:US
Mailing Address - Phone:480-301-8297
Mailing Address - Fax:480-301-6258
Practice Address - Street 1:13400 E SHEA BLVD
Practice Address - Street 2:MAYO CLINIC - PSYCHOLOGY
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5404
Practice Address - Country:US
Practice Address - Phone:480-301-8297
Practice Address - Fax:480-301-6258
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3650103G00000X
AZ03650103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ874736Medicaid
AZP00749853OtherRAILROAD MEDICARE
AZ874736Medicaid
AZ84298Medicare ID - Type UnspecifiedMEDICARE #
AZP00749853OtherRAILROAD MEDICARE