Healthcare Provider Details

I. General information

NPI: 1699255448
Provider Name (Legal Business Name): KATHERINE BRINTON HURLEY ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2046 ALLEN AVE # 100
ALTADENA CA
91001-3424
US

IV. Provider business mailing address

1414 QUINTERO ST APT 2
LOS ANGELES CA
90026-3459
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-3600
  • Fax:
Mailing address:
  • Phone: 847-309-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number89658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: