Healthcare Provider Details

I. General information

NPI: 1053624312
Provider Name (Legal Business Name): DANIELLE HURWITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N ORANGE GROVE BLVD
PASADENA CA
91103-3333
US

IV. Provider business mailing address

855 N ORANGE GROVE BLVD
PASADENA CA
91103-3333
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-3453
  • Fax:
Mailing address:
  • Phone: 626-796-3453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW31860
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW65734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: