MEDICARE: DEBRA K. HIRSCHBERG AND ASSOCIATES, INC.

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	22550	IL
2	101YM0800X	Mental Health Counselor
3	103TC0700X	Clinical Psychologist
4	101Y00000X	Counselor		IL
5	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1245417302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBRA K. HIRSCHBERG AND ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	185 HERITAGE DR # 1
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8068
Country	:	US
Telephone Number	:	847-705-3199
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 HILL AVE
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60120-4412
Country	:	US
Telephone Number	:	847-695-8010
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. DEBRA K. HIRSCHBERG
Credential	:	LCSW
Telephone Number	:	847-612-4309

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	01/30/2008

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