Basic Information
| Provider Information | |||||||||
| NPI: | 1043499742 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRWAN | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4102 PINION DR 10 MDG | ||||||||
| Address2: | |||||||||
| City: | USAF | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193335177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 325 MDG, 340 MAGNOLIA CIRCLE | ||||||||
| Address2: | |||||||||
| City: | TYNDALL AFB | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502837511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2007 | ||||||||
| LastUpdateDate: | 08/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 102100000X | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.