Provider Demographics
NPI:1366054744
Name:ELLEN HIRSHBERG
Entity type:Organization
Organization Name:ELLEN HIRSHBERG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:603-205-5946
Mailing Address - Street 1:2456 LAFAYETTE ROAD SUITE 12
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-0000
Mailing Address - Country:US
Mailing Address - Phone:603-205-5946
Mailing Address - Fax:603-836-4389
Practice Address - Street 1:2456 LAFAYETTE ROAD SUITE 12
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-0000
Practice Address - Country:US
Practice Address - Phone:603-205-5946
Practice Address - Fax:603-836-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty