Provider Demographics
NPI:1871622035
Name:HIRSCHORN, GLADYS I (PHD)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:I
Last Name:HIRSCHORN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 S LIVINGSTON AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3071
Mailing Address - Country:US
Mailing Address - Phone:973-740-9440
Mailing Address - Fax:973-740-8932
Practice Address - Street 1:160 S LIVINGSTON AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3071
Practice Address - Country:US
Practice Address - Phone:973-740-9440
Practice Address - Fax:973-740-8932
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI100239400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
650023Medicare ID - Type Unspecified