Provider Demographics
NPI:1275603805
Name:HIRSCH-GEFFNER, AMANDA EMILY (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:EMILY
Last Name:HIRSCH-GEFFNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-2723
Mailing Address - Country:US
Mailing Address - Phone:917-439-7405
Mailing Address - Fax:
Practice Address - Street 1:1200 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905
Practice Address - Country:US
Practice Address - Phone:917-439-7405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR056084-11041C0700X
CT0072021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP1534265OtherOXFORD PROVIDER ID #
NYNE3502Medicare ID - Type UnspecifiedMANHATTAN OFFICE
NYP1534265OtherOXFORD PROVIDER ID #