Provider Demographics
NPI:1578570735
Name:HIRSCH, STEVEN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
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 1:1 RICHMOND SQ STE 104C
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5154
Mailing Address - Country:US
Mailing Address - Phone:401-272-9666
Mailing Address - Fax:
Practice Address - Street 1:1 RICHMOND SQ STE 104C
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5154
Practice Address - Country:US
Practice Address - Phone:401-272-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2659103G00000X
RI205103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist