Provider Demographics
NPI:1003879339
Name:HIRSH, RONNIE MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:MICHAEL
Last Name:HIRSH
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 1:61 W 9TH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8975
Mailing Address - Country:US
Mailing Address - Phone:212-995-0969
Mailing Address - Fax:
Practice Address - Street 1:61 W 9TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8975
Practice Address - Country:US
Practice Address - Phone:212-995-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-000086101YM0800X
NY06-000025106H00000X
VA0701001436101YP2500X
NY345528146N00000X
VA0701000134106H00000X
FLMH8347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
112494977OtherTAX ID