Provider Demographics
NPI:1649308560
Name:WIRTH, MARY ANGELA
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANGELA
Last Name:WIRTH
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 1:5013 VINEYARD PT
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3664
Mailing Address - Country:US
Mailing Address - Phone:502-836-0918
Mailing Address - Fax:
Practice Address - Street 1:230 VENTURE CIR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1604
Practice Address - Country:US
Practice Address - Phone:615-460-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker