Healthcare Provider Details

I. General information

NPI: 1750666137
Provider Name (Legal Business Name): HIRSCH M ISEN LCSWC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12120 PLUM ORCHARD DR
SILVER SPRING MD
20904-7820
US

IV. Provider business mailing address

12120 PLUM ORCHARD DR
SILVER SPRING MD
20904-7820
US

V. Phone/Fax

Practice location:
  • Phone: 301-572-6585
  • Fax: 301-572-5062
Mailing address:
  • Phone: 301-572-6585
  • Fax: 301-572-5062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17121
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier17121
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerMD. STATE BOARD OF SOCIAL WORK EXAMINERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: