| Andrea E Kirk Phd | |
|
309 S Main St Sebastopol CA 95472-4208 | |
| (707) 939-5475 | |
| Not Available |
| Full Name | Andrea E Kirk Phd |
|---|---|
| Speciality | Psychologist |
| Location | 309 S Main St, Sebastopol, California |
| Authorized Official Name and Position | Andrea Kirk (OWNER) |
| Authorized Official Contact | 7073935475 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Andrea E Kirk Phd 309 S Main St Sebastopol CA 95472-4208 Ph: (707) 939-5475 | Andrea E Kirk Phd 309 S Main St Sebastopol CA 95472-4208 Ph: (707) 939-5475 |
| NPI Number | 1306601158 |
|---|---|
| Provider Enumeration Date | 02/20/2024 |
| Last Update Date | 02/20/2024 |
| Certification Date | 02/20/2024 |
| Medicare PECOS PAC ID | 9537605787 |
|---|---|
| Medicare Enrollment ID | O20240723004864 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306601158 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Andrea Elizabeth Kirk |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760939318 PECOS PAC ID: 7810272812 Enrollment ID: I20170313002017 |
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