Provider Demographics
NPI:1003179789
Name:HIRSCH, SUSAN BETH (SPECIAL EDUCATION M)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETH
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:SPECIAL EDUCATION M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 EXECUTIVE DR STE LL108
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 EXECUTIVE DR STE LL108
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1707
Practice Address - Country:US
Practice Address - Phone:516-576-2040
Practice Address - Fax:516-576-2131
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$-TOtherMEDICARE