Provider Demographics
NPI:1982028882
Name:HIRSCHBERG, RANDI JO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RANDI
Middle Name:JO
Last Name:HIRSCHBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W 59TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1047
Mailing Address - Country:US
Mailing Address - Phone:617-835-1012
Mailing Address - Fax:
Practice Address - Street 1:23 W 73RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3104
Practice Address - Country:US
Practice Address - Phone:617-835-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020460103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist