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NPI Code Detail

MEDICARE: BROOKE HIRSH

MEDICARE: BROOKE HIRSH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist0803000308VA

General Provider Information

NPI Number : 1073281465
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE HIRSH
Provider Business Mailing Address
First Line : 255 E SOUTH BLVD
Second Line :
City : PETERSBURG
State : VA
Zip : 23805-2700
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 255 E SOUTH BLVD
Second Line :
City : PETERSBURG
State : VA
Zip : 23805-2700
Country : US
Telephone Number : 804-720-9304
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2021
Last Update Date : 05/28/2026

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Directions to “ BROOKE HIRSH ” Practice Location

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