Healthcare Provider Details

I. General information

NPI: 1336641588
Provider Name (Legal Business Name): KATHRYN LYNN HURLEY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATY HURLEY-GOSCH MBA

II. Dates (important events)

Enumeration Date: 03/04/2018
Last Update Date: 03/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

4325 E COOPER CIR
TUCSON AZ
85711-4233
US

V. Phone/Fax

Practice location:
  • Phone: 201-978-9840
  • Fax:
Mailing address:
  • Phone: 201-978-9840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number909
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: