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NPI Code Detail

MEDICARE: TERA GRETCHEN HIRSCH L.I.C.S.W., PH.D.

MEDICARE:   TERA GRETCHEN HIRSCH  L.I.C.S.W., PH.D.
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
1101YM0800XMental Health Counselor111271MA

General Provider Information

NPI Number : 1386792661
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERA GRETCHEN HIRSCH L.I.C.S.W., PH.D.
Provider Business Mailing Address
First Line : 43 CLYDE ST
Second Line :
City : NEWTON
State : MA
Zip : 02460-2208
Country : US
Telephone Number : 617-413-5969
Fax Number :
Provider Business Practice Location Address
First Line : 233 HARVARD ST STE 305
Second Line :
City : BROOKLINE
State : MA
Zip : 02446-5017
Country : US
Telephone Number : 617-413-5969
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2007
Last Update Date : 07/09/2007

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Directions to “ TERA GRETCHEN HIRSCH L.I.C.S.W., PH.D.” Practice Location

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