Provider Demographics
NPI:1255797361
Name:HIRSCHMAN, MIRANDA (LCSW)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:HIRSCHMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10674 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-1384
Mailing Address - Country:US
Mailing Address - Phone:716-532-3325
Mailing Address - Fax:716-995-2155
Practice Address - Street 1:10674 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1384
Practice Address - Country:US
Practice Address - Phone:716-532-3325
Practice Address - Fax:716-995-2155
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY097104-011041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor