Provider Demographics
NPI:1255677589
Name:HIRTH, ERICA (MFT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:HIRTH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 HAYNES ST
Mailing Address - Street 2:MANCHESTER MEMORIAL HOSPITAL
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4131
Mailing Address - Country:US
Mailing Address - Phone:860-647-6827
Mailing Address - Fax:860-533-3452
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:MANCHESTER MEMORIAL HOSPITAL
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-647-6827
Practice Address - Fax:860-533-3452
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004025177Medicaid