Healthcare Provider Details

I. General information

NPI: 1386938835
Provider Name (Legal Business Name): MAUREEN C HURLEY MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 COTTAGE WAY SUITE 7
SACRAMENTO CA
95825-1218
US

IV. Provider business mailing address

PO BOX 5157
MODESTO CA
95352-5157
US

V. Phone/Fax

Practice location:
  • Phone: 916-489-1376
  • Fax: 916-489-1386
Mailing address:
  • Phone: 209-572-2589
  • Fax: 209-572-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-02-0793
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: