=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700892908
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENNETT ZEBULUN HIRSCH PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 SALT POND ROAD SUITE D-4
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-789-3694
-----------------------------------------------------
Fax | 401-789-3748
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 HAWTHORNE RD
-----------------------------------------------------
City | JAMESTOWN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-423-1188
-----------------------------------------------------
Fax | 401-789-3748
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 380
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------