Provider Demographics
NPI:1356454532
Name:HIRSHBERG, ELLEN (LCPC LCMHC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:HIRSHBERG
Suffix:
Gender:F
Credentials:LCPC LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ISLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7237
Mailing Address - Country:US
Mailing Address - Phone:603-205-5946
Mailing Address - Fax:207-282-7509
Practice Address - Street 1:240 ISLINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7237
Practice Address - Country:US
Practice Address - Phone:603-205-5946
Practice Address - Fax:207-282-7509
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431748299Medicaid