Healthcare Provider Details

I. General information

NPI: 1407197387
Provider Name (Legal Business Name): JAMES VINCENT KIRBY II L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2013
Last Update Date: 03/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 CHERRY LN
CLOVIS CA
93612-0908
US

IV. Provider business mailing address

341 CHERRY LN
CLOVIS CA
93612-0908
US

V. Phone/Fax

Practice location:
  • Phone: 559-779-9864
  • Fax: 559-298-3106
Mailing address:
  • Phone: 559-779-9864
  • Fax: 559-298-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number22941
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: