Provider Demographics
NPI:1174078984
Name:KIRBY, PEGGY LYNN
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LYNN
Last Name:KIRBY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PEGGY
Other - Middle Name:L
Other - Last Name:KIRBY-SEWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCABA 0-03-0734
Mailing Address - Street 1:230 11TH CT
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-2837
Mailing Address - Country:US
Mailing Address - Phone:772-532-8321
Mailing Address - Fax:
Practice Address - Street 1:230 11TH CT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-2837
Practice Address - Country:US
Practice Address - Phone:772-532-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-03-0734103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst