Healthcare Provider Details

I. General information

NPI: 1851358105
Provider Name (Legal Business Name): ANTHONY J KIRTSOS JR. LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E MAIN ST STE A
SALISBURY MD
21801-5044
US

IV. Provider business mailing address

220 E MAIN ST STE A
SALISBURY MD
21801-5044
US

V. Phone/Fax

Practice location:
  • Phone: 410-860-9600
  • Fax: 410-860-8511
Mailing address:
  • Phone: 410-860-9600
  • Fax: 410-860-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberG11016
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: