MEDICARE: MR. CHARLES F. KIRBY III LMSW-CC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	1041C0700X	Clinical Social Worker	MC11253	ME

General Provider Information

NPI Number	:	1306094297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES F. KIRBY III LMSW-CC

Provider Business Mailing Address
First Line	:	30 HAZEL TER STE 11
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2240
Country	:	US
Telephone Number	:	203-819-7650
Fax Number	:	203-597-8860

Provider Business Practice Location Address
First Line	:	30 HAZEL TER STE 11
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2240
Country	:	US
Telephone Number	:	203-819-7650
Fax Number	:	203-298-9487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	07/21/2024

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