Healthcare Provider Details

I. General information

NPI: 1114502978
Provider Name (Legal Business Name): LOUIS HURWITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2021
Last Update Date: 03/13/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 BRADLEY ST
BRISTOL CT
06010-5103
US

IV. Provider business mailing address

301 CANDLEWOOD DR
BRISTOL CT
06010-7967
US

V. Phone/Fax

Practice location:
  • Phone: 860-406-2437
  • Fax:
Mailing address:
  • Phone: 860-406-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4800
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: