Healthcare Provider Details

I. General information

NPI: 1003879339
Provider Name (Legal Business Name): RONNIE MICHAEL HIRSH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 W 9TH ST SUITE 1A
NEW YORK NY
10011-8975
US

IV. Provider business mailing address

61 W 9TH ST SUITE 1A
NEW YORK NY
10011-8975
US

V. Phone/Fax

Practice location:
  • Phone: 212-995-0969
  • Fax:
Mailing address:
  • Phone: 212-995-0969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18-000086
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number06-000025
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701001436
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number345528
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0701000134
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8347
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: