Provider Demographics
NPI:1588655864
Name:HERSHORN, MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HERSHORN
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:PO BOX 9318
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33075-9318
Mailing Address - Country:US
Mailing Address - Phone:954-614-2326
Mailing Address - Fax:954-752-5246
Practice Address - Street 1:7301 N UNIVERSITY DR
Practice Address - Street 2:SUITE 209
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2919
Practice Address - Country:US
Practice Address - Phone:954-614-2326
Practice Address - Fax:954-752-5246
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003824103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
75879Medicare ID - Type Unspecified