MEDICARE: MR. HIRSCH M ISEN LCSWC

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	1041C0700X	Clinical Social Worker	17121	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17121	OTHER	MD	MD. STATE BOARD OF SOCIAL WORK EXAMINERS

General Provider Information

NPI Number	:	1750666137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HIRSCH M ISEN LCSWC

Provider Business Mailing Address
First Line	:	12120 PLUM ORCHARD DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7820
Country	:	US
Telephone Number	:	301-572-6585
Fax Number	:	301-572-5062

Provider Business Practice Location Address
First Line	:	12120 PLUM ORCHARD DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7820
Country	:	US
Telephone Number	:	301-572-6585
Fax Number	:	301-572-5062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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