Provider Demographics
NPI:1205982477
Name:HERSHMAN, MARK J (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:HERSHMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BEDFORD RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2135
Mailing Address - Country:US
Mailing Address - Phone:914-232-1730
Mailing Address - Fax:
Practice Address - Street 1:51 BEDFORD RD
Practice Address - Street 2:SUITE 5
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2135
Practice Address - Country:US
Practice Address - Phone:914-232-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8937103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
65684OtherCIGNA BEHAVIORAL HEALTH
135825OtherVALUE OPTIONS PROVIDER #
NY01213038Medicaid
NY01213038Medicaid