Provider Demographics
NPI:1972759223
Name:HIRSH, WAYNE CARL (PHD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:CARL
Last Name:HIRSH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 VIA NONA MARIE
Mailing Address - Street 2:205
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8614
Mailing Address - Country:US
Mailing Address - Phone:831-622-9567
Mailing Address - Fax:831-622-7222
Practice Address - Street 1:3855 VIA NONA MARIE
Practice Address - Street 2:205
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8614
Practice Address - Country:US
Practice Address - Phone:831-622-9567
Practice Address - Fax:831-622-7222
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical