Provider Demographics
NPI:1487838504
Name:HIRSCH, ROBERT EDWIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWIN
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3356 2ND AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5636
Mailing Address - Country:US
Mailing Address - Phone:619-688-9557
Mailing Address - Fax:619-255-2900
Practice Address - Street 1:3356 2ND AVE
Practice Address - Street 2:SUITE G
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5636
Practice Address - Country:US
Practice Address - Phone:619-688-9557
Practice Address - Fax:619-255-2900
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15222103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist