Provider Demographics
NPI:1518228725
Name:KIRBY, KENTON PHILLIP (LMSW)
Entity Type:Individual
Prefix:MR
First Name:KENTON
Middle Name:PHILLIP
Last Name:KIRBY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 62ND ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2641
Mailing Address - Country:US
Mailing Address - Phone:917-518-6979
Mailing Address - Fax:
Practice Address - Street 1:2327 62ND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2641
Practice Address - Country:US
Practice Address - Phone:917-518-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical