Healthcare Provider Details

I. General information

NPI: 1962601427
Provider Name (Legal Business Name): ANDREW J WURTH LICSW, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2007
Last Update Date: 07/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HODGES AVE
TAUNTON MA
02780-3034
US

IV. Provider business mailing address

880 S RIVER ST
MARSHFIELD MA
02050-2550
US

V. Phone/Fax

Practice location:
  • Phone: 508-828-3200
  • Fax:
Mailing address:
  • Phone: 781-834-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110847
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: