Provider Demographics
NPI:1740230655
Name:KIRSNERS, ERICA (LICSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:KIRSNERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2917
Mailing Address - Country:US
Mailing Address - Phone:617-566-2153
Mailing Address - Fax:
Practice Address - Street 1:344 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2917
Practice Address - Country:US
Practice Address - Phone:617-566-2153
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1029231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01694OtherBLUE CROSS/BLUE SHIELD
MA1858343Medicaid
MAP01694OtherBLUE CROSS/BLUE SHIELD