Provider Demographics
NPI:1144605593
Name:HIRSCH, JACQUELYN NICOLE (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:NICOLE
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:PISANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:124 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1062
Practice Address - Country:US
Practice Address - Phone:410-219-5483
Practice Address - Fax:410-219-5486
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD209121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
MD211833Medicare Oscar/Certification
MDS118Medicare PIN