=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659428670
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAMIAN MICHAEL KIRWAN LCSW, DCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2702 N 3RD ST SUITE 2000
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85004-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-738-5487
-----------------------------------------------------
Fax | 602-279-1431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1227 E LAGUNA DR
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-5517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-844-7823
-----------------------------------------------------
Fax | 480-844-0463
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW-38391
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------