Provider Demographics
NPI:1134383029
Name:CIRESI, KYLE B (MSW, LCSW, LCAC)
Entity type:Individual
Prefix:MRS
First Name:KYLE
Middle Name:B
Last Name:CIRESI
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 W SMITH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-8495
Mailing Address - Country:US
Mailing Address - Phone:317-509-0837
Mailing Address - Fax:
Practice Address - Street 1:3209 W SMITH VALLEY RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-8495
Practice Address - Country:US
Practice Address - Phone:317-509-0837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IN34005803A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100264520Medicaid