MEDICARE: MR. KENTON PHILLIP KIRBY LMSW

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

General Provider Information

NPI Number	:	1518228725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENTON PHILLIP KIRBY LMSW

Provider Business Mailing Address
First Line	:	2327 62ND ST
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2641
Country	:	US
Telephone Number	:	917-518-6979
Fax Number	:

Provider Business Practice Location Address
First Line	:	2327 62ND ST
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2641
Country	:	US
Telephone Number	:	917-518-6979
Fax Number	:

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	07/16/2013

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