Provider Demographics
NPI:1942353933
Name:WIRTH, DENISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:WIRTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 W LAKE AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BAY HEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-5000
Mailing Address - Country:US
Mailing Address - Phone:732-899-9959
Mailing Address - Fax:732-830-5465
Practice Address - Street 1:571 W LAKE AVE STE 6
Practice Address - Street 2:
Practice Address - City:BAY HEAD
Practice Address - State:NJ
Practice Address - Zip Code:08742-5000
Practice Address - Country:US
Practice Address - Phone:732-899-9959
Practice Address - Fax:732-830-5465
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC051895001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical