MEDICARE: ABBI WIRTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	2996	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154865772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBI WIRTA

Provider Business Mailing Address
First Line	:	20 ROCHE BROTHERS WAY STE 6-381
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-1030
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 ROCHE BROS WAY STE 6-381
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-1030
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2016
Last Update Date	:	04/22/2024

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Directions to “ ABBI WIRTA ” Practice Location

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