Provider Demographics
NPI:1285414524
Name:HIRSCHY, ETHAN JAMES
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:JAMES
Last Name:HIRSCHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7623 PLACER RUN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-8256
Mailing Address - Country:US
Mailing Address - Phone:260-494-5701
Mailing Address - Fax:
Practice Address - Street 1:7623 PLACER RUN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-8256
Practice Address - Country:US
Practice Address - Phone:260-494-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty