Provider Demographics
NPI:1194039073
Name:HIRTZ, SUSAN GAIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GAIL
Last Name:HIRTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SEALY CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-2411
Mailing Address - Country:US
Mailing Address - Phone:516-569-1487
Mailing Address - Fax:516-569-1487
Practice Address - Street 1:9 SEALY CT
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-2411
Practice Address - Country:US
Practice Address - Phone:516-569-1487
Practice Address - Fax:516-569-1487
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010579-1103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent