Provider Demographics
NPI:1871873968
Name:KIRBY, AMBER (LCSW, CSAC)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:HIBBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APSW, CSAC
Mailing Address - Street 1:2625 N WEIL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3060
Mailing Address - Country:US
Mailing Address - Phone:262-945-2012
Mailing Address - Fax:
Practice Address - Street 1:2625 N WEIL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3060
Practice Address - Country:US
Practice Address - Phone:262-945-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8299-123104100000X
WI205151827101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871873968Medicaid