MEDICARE: ANDREA HURLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1760136980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA HURLEY

Provider Business Mailing Address
First Line	:	225 CEDAR HILL ST STE 200
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-5900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3228 S GARRISON ST APT 295
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-4649
Country	:	US
Telephone Number	:	720-926-3037
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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