Provider Demographics
NPI:1801580188
Name:KIRK, BRIANNA A
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:A
Last Name:KIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MATTHEW BATHON CT
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-3668
Mailing Address - Country:US
Mailing Address - Phone:443-350-5222
Mailing Address - Fax:
Practice Address - Street 1:253 LEWIS LN STE 101
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3755
Practice Address - Country:US
Practice Address - Phone:410-780-7178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30054104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker