Healthcare Provider Details

I. General information

NPI: 1497392054
Provider Name (Legal Business Name): KAREN JANE KIRBY LCSW,LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N KING ST
GLOUCESTER CITY NJ
08030-1417
US

IV. Provider business mailing address

106 TAVISTOCK
CHERRY HILL NJ
08034-4001
US

V. Phone/Fax

Practice location:
  • Phone: 856-742-0900
  • Fax: 856-742-0811
Mailing address:
  • Phone: 856-883-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05898800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: