Provider Demographics
NPI:1760570469
Name:LICHT HIRSCH, LISA MARGOT (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARGOT
Last Name:LICHT HIRSCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LISA MARGOT
Other - Middle Name:LICHT
Other - Last Name:HIRSCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2745 NETHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4810
Mailing Address - Country:US
Mailing Address - Phone:914-309-7672
Mailing Address - Fax:
Practice Address - Street 1:154 W 70TH ST APT 7E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4496
Practice Address - Country:US
Practice Address - Phone:914-309-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015637-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300052471OtherMEDICARE PTAN