Provider Demographics
NPI:1700892908
Name:HIRSCH, BENNETT ZEBULUN (PHD)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:ZEBULUN
Last Name:HIRSCH
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 1:29 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835
Mailing Address - Country:US
Mailing Address - Phone:401-423-1188
Mailing Address - Fax:401-789-3748
Practice Address - Street 1:24 SALT POND ROAD
Practice Address - Street 2:SUITE D-4
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-789-3694
Practice Address - Fax:401-789-3748
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI380103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6154212OtherUNITED HEALTHCARE
RI93338OtherRI BLUE CROSS
RIBH08473Medicaid
RI69009333Medicare ID - Type Unspecified