Provider Demographics
NPI:1801082631
Name:WRIGHT, MARY BIRCH (MSW LCSW, BCBA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BIRCH
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MSW LCSW, BCBA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:BIRCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5557 SW CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-5090
Mailing Address - Country:US
Mailing Address - Phone:772-221-1222
Mailing Address - Fax:
Practice Address - Street 1:5557 SW CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-5090
Practice Address - Country:US
Practice Address - Phone:772-221-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-13586103K00000X
FLSW 102211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical