Provider Demographics
NPI:1629308499
Name:HIRSCH, STEFANI AUGER (LCSW)
Entity Type:Individual
Prefix:
First Name:STEFANI
Middle Name:AUGER
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEFANI
Other - Middle Name:ANNE
Other - Last Name:AUGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:854 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2712
Mailing Address - Country:US
Mailing Address - Phone:207-329-7495
Mailing Address - Fax:
Practice Address - Street 1:854 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2712
Practice Address - Country:US
Practice Address - Phone:207-329-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC130361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434169099Medicaid
ME002436001Medicare PIN