Provider Demographics
NPI:1851361273
Name:HIRSCHORN, STEPHEN I (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:I
Last Name:HIRSCHORN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:HIRSCHORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4400 BAYOU BLVD
Mailing Address - Street 2:BUILDING 51
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2673
Mailing Address - Country:US
Mailing Address - Phone:850-484-8344
Mailing Address - Fax:850-484-2875
Practice Address - Street 1:4400 BAYOU BLVD
Practice Address - Street 2:BUILDING 51
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2673
Practice Address - Country:US
Practice Address - Phone:850-484-8344
Practice Address - Fax:850-484-2875
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2286103T00000X
FLMT900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592388587OtherTIN
FLNPP000Medicare UPIN
FL73138Medicare ID - Type UnspecifiedPROVIDER ID