Provider Demographics
NPI:1316016215
Name:KIRSCH, PAULA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:ANN
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1444
Mailing Address - Country:US
Mailing Address - Phone:516-466-4562
Mailing Address - Fax:516-466-2123
Practice Address - Street 1:55 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1444
Practice Address - Country:US
Practice Address - Phone:516-466-4562
Practice Address - Fax:516-466-2123
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0047441103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V56621Medicare ID - Type Unspecified