Provider Demographics
NPI:1851358105
Name:KIRTSOS, ANTHONY J JR (LGSW)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:KIRTSOS
Suffix:JR
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5044
Mailing Address - Country:US
Mailing Address - Phone:410-860-9600
Mailing Address - Fax:410-860-8511
Practice Address - Street 1:220 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5044
Practice Address - Country:US
Practice Address - Phone:410-860-9600
Practice Address - Fax:410-860-8511
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG110161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD774800100Medicaid