Provider Demographics
NPI:1972691095
Name:DANA-KIRBY, LESLIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:DANA-KIRBY
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 1:14635 W FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8279
Mailing Address - Country:US
Mailing Address - Phone:623-606-7243
Mailing Address - Fax:
Practice Address - Street 1:14780 W MOUNTAIN VIEW BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4799
Practice Address - Country:US
Practice Address - Phone:623-374-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3320103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist