Provider Demographics
NPI:1134326192
Name:HIRSHENBAUM, GEO-ANNA QUINTANILLA (PHD)
Entity type:Individual
Prefix:
First Name:GEO-ANNA
Middle Name:QUINTANILLA
Last Name:HIRSHENBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7272 WURZBACH RD 706
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4803
Mailing Address - Country:US
Mailing Address - Phone:210-615-3483
Mailing Address - Fax:
Practice Address - Street 1:14100 KARISSA CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-3866
Practice Address - Country:US
Practice Address - Phone:210-615-3483
Practice Address - Fax:210-593-9863
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37194103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186053803Medicaid
TX186053802Medicaid
TX186053801Medicaid