Provider Demographics
NPI:1861616559
Name:HIRSCH, LORENA M (MC)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:M
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 E THOMAS RD STE 385
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7866
Mailing Address - Country:US
Mailing Address - Phone:602-955-3429
Mailing Address - Fax:602-955-3430
Practice Address - Street 1:2345 E THOMAS RD STE 385
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7866
Practice Address - Country:US
Practice Address - Phone:602-955-3429
Practice Address - Fax:602-955-3430
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10589101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional