Provider Demographics
NPI:1518095975
Name:HIRT, AMY J (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:HIRT
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 1:583 DEER CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:HAINESVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3855
Mailing Address - Country:US
Mailing Address - Phone:847-345-2090
Mailing Address - Fax:847-201-2687
Practice Address - Street 1:408 CENTER ST
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1626
Practice Address - Country:US
Practice Address - Phone:847-345-2090
Practice Address - Fax:847-201-2687
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490118121041C0700X
IN34008499A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical