Provider Demographics
NPI:1073002655
Name:HIRSCH, DEBRA PARKER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:PARKER
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WESTHAVEN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3264
Mailing Address - Country:US
Mailing Address - Phone:618-257-9201
Mailing Address - Fax:618-257-9310
Practice Address - Street 1:118 WESTHAVEN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-3264
Practice Address - Country:US
Practice Address - Phone:618-257-9201
Practice Address - Fax:618-257-9310
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490094091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1467590166Medicaid