Provider Demographics
NPI:1922304245
Name:WIRTH, MARY MARGARET (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:WIRTH
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:WIRTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:589 WEST HOLLIS STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062
Mailing Address - Country:US
Mailing Address - Phone:603-921-6226
Mailing Address - Fax:603-821-6142
Practice Address - Street 1:589 WEST HOLLIS STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062
Practice Address - Country:US
Practice Address - Phone:603-921-6226
Practice Address - Fax:603-821-6142
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH842101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3071879Medicaid
NH30428662Medicaid
NH3077805Medicaid