MEDICARE: MRS. MARCIA WYRTZEN LCSW

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	1041C0700X	Clinical Social Worker	44SC04531700	NJ

General Provider Information

NPI Number	:	1932176179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCIA WYRTZEN LCSW

Provider Business Mailing Address
First Line	:	42-31 NAUGLE DR
Second Line	:
City	:	FAIR LAWN
State	:	NJ
Zip	:	07410-5938
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 E ALLENDALE AVE
Second Line	:
City	:	ALLENDALE
State	:	NJ
Zip	:	07401-2095
Country	:	US
Telephone Number	:	201-327-2424
Fax Number	:

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	07/08/2007

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