Healthcare Provider Details

I. General information

NPI: 1154634830
Provider Name (Legal Business Name): VERONICA L KIRBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 GANDY BLVD N SUITE 304
PINELLAS PARK FL
33781-2658
US

IV. Provider business mailing address

13220 OLD FLORIDA CIR
HUDSON FL
34669-2890
US

V. Phone/Fax

Practice location:
  • Phone: 727-547-0607
  • Fax:
Mailing address:
  • Phone: 727-410-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1074131
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: