Provider Demographics
NPI:1518023225
Name:BIRK, MARY G
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:G
Last Name:BIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7731 W NEWBERRY RD
Mailing Address - Street 2:1A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6725
Mailing Address - Country:US
Mailing Address - Phone:352-332-8600
Mailing Address - Fax:352-332-8911
Practice Address - Street 1:7731 W NEWBERRY RD
Practice Address - Street 2:1A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6725
Practice Address - Country:US
Practice Address - Phone:352-332-8600
Practice Address - Fax:352-332-8911
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health