Healthcare Provider Details

I. General information

NPI: 1548240393
Provider Name (Legal Business Name): MARK WILLIAM FIRTH MSW MA LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 ROUTE 57 W
WASHINGTON NJ
07882-4338
US

IV. Provider business mailing address

240 ROSEHILL AVE
PHILLIPSBURG NJ
08865-1752
US

V. Phone/Fax

Practice location:
  • Phone: 908-689-1000
  • Fax: 908-689-4529
Mailing address:
  • Phone: 908-387-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC00637700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: