Provider Demographics
NPI:1841944931
Name:VAN LIEROP, KIRBY LASHAY (LCSW)
Entity type:Individual
Prefix:
First Name:KIRBY
Middle Name:LASHAY
Last Name:VAN LIEROP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIRBY
Other - Middle Name:
Other - Last Name:GREIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-559-9425
Mailing Address - Fax:
Practice Address - Street 1:1000 DUPONT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4611
Practice Address - Country:US
Practice Address - Phone:502-899-6405
Practice Address - Fax:502-599-6407
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100797880Medicaid