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General NPI Number Information
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NPI Number | 1720286982
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Entity Type | Individual
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Provider Name | NICOLE M KIRBY LCMHC
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 229 WESTERN AVENUE
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City | BRATTLEBORO
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State | VT
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Zip | 05301
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Country | US
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Telephone | 347-342-6259
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Fax | 802-419-9706
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Provider Business Mailing Address
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Address Line | PO BOX 301
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City | EAST DOVER
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State | VT
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Zip | 05341
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Country | US
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Telephone | 347-342-6259
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Fax | 802-419-9706
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 005155-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 068.0087757
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 068.0087757
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License Number State | VT
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