Provider Demographics
NPI:1003882440
Name:KIRSCH, AUDREY (MSW)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2211
Mailing Address - Country:US
Mailing Address - Phone:516-931-3163
Mailing Address - Fax:516-396-2145
Practice Address - Street 1:333 GLEN HEAD RD
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1947
Practice Address - Country:US
Practice Address - Phone:516-647-5066
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR024762-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical