Individual
EVELYN DIANE KIRKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
68 S MAIN ST, SUITE 202, WEST HARTFORD, CT 06107-2445
(860) 521-7111
(860) 561-6184
Mailing address
68 S MAIN ST, SUITE 202, WEST HARTFORD, CT 06107-2445
(860) 521-7111
(860) 561-6184
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
000108
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079556
MHN PROVIDER #
CT
01
—
140000108CT04
ANTHEM BCBS PROVIDER #
CT
Enumeration date
07/31/2006
Last updated
07/08/2007
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