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General NPI Number Information
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NPI Number | 1639210776
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Entity Type | Individual
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Provider Name | LISA KIRK LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 50 SANITORIUM RD BLDG F
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City | POMONA
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State | NY
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Zip | 10970-3555
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Country | US
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Telephone | 845-364-2275
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Fax |
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Provider Business Mailing Address
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Address Line | 11 ACKERMAN AVE
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City | AIRMONT
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State | NY
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Zip | 10901-7119
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Country | US
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Telephone | 845-357-2084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 33151
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License Number State | NY
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