Provider Demographics
NPI:1114142080
Name:HIRSCH, MARJORIE DYAN (LCSW, CASAC, CEAP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:DYAN
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:LCSW, CASAC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WEST 34TH STREET
Mailing Address - Street 2:ROOM 1200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3006
Mailing Address - Country:US
Mailing Address - Phone:212-353-1869
Mailing Address - Fax:212-353-1869
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:ROOM 1200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:212-353-1869
Practice Address - Fax:212-353-1869
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW-R #03935811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical