Provider Demographics
NPI:1225120223
Name:HIRSHFELD, MARK A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:HIRSHFELD
Suffix:
Gender:M
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:PO BOX 824
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376-0824
Mailing Address - Country:US
Mailing Address - Phone:805-216-2918
Mailing Address - Fax:
Practice Address - Street 1:3585 MAPLE ST
Practice Address - Street 2:SUITE 265
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3504
Practice Address - Country:US
Practice Address - Phone:805-658-9900
Practice Address - Fax:805-658-9900
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS147881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA353373OtherMANAGED HEALTH NETWORK, I