Healthcare Provider Details

I. General information

NPI: 1932176179
Provider Name (Legal Business Name): MARCIA WYRTZEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 E ALLENDALE AVE
ALLENDALE NJ
07401-2095
US

IV. Provider business mailing address

42-31 NAUGLE DR
FAIR LAWN NJ
07410-5938
US

V. Phone/Fax

Practice location:
  • Phone: 201-327-2424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04531700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: