Healthcare Provider Details

I. General information

NPI: 1366414237
Provider Name (Legal Business Name): ROBERT JOSEPH HURLEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 MAIN ST STE 208
STRATFORD CT
06615-5813
US

IV. Provider business mailing address

54 ROLLING WOOD DR
TRUMBULL CT
06611-4926
US

V. Phone/Fax

Practice location:
  • Phone: 203-386-1977
  • Fax: 203-386-1977
Mailing address:
  • Phone: 203-371-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1084
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: