Healthcare Provider Details

I. General information

NPI: 1659428670
Provider Name (Legal Business Name): DAMIAN MICHAEL KIRWAN LCSW, DCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 N 3RD ST SUITE 2000
PHOENIX AZ
85004-1130
US

IV. Provider business mailing address

1227 E LAGUNA DR
TEMPE AZ
85282-5517
US

V. Phone/Fax

Practice location:
  • Phone: 602-738-5487
  • Fax: 602-279-1431
Mailing address:
  • Phone: 480-844-7823
  • Fax: 480-844-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW-38391
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: