Provider Demographics
NPI:1902886633
Name:KIRK ELDER, DEBORAH (MSW, ACSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KIRK ELDER
Suffix:
Gender:F
Credentials:MSW, ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E RIVER RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6514
Mailing Address - Country:US
Mailing Address - Phone:520-577-3652
Mailing Address - Fax:520-577-3516
Practice Address - Street 1:2200 E RIVER RD
Practice Address - Street 2:SUITE 121
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6514
Practice Address - Country:US
Practice Address - Phone:520-577-3652
Practice Address - Fax:520-577-3516
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW05581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ799322Medicaid
AZ799322Medicaid