Healthcare Provider Details

I. General information

NPI: 1366835712
Provider Name (Legal Business Name): STEPHEN HURLEY MS, NCC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E MAIN ST
WATERBURY CT
06702-2310
US

IV. Provider business mailing address

141 E MAIN ST 4TH FLOOR ADMINISTRATION
WATERBURY CT
06702-2310
US

V. Phone/Fax

Practice location:
  • Phone: 203-756-7287
  • Fax: 203-596-0722
Mailing address:
  • Phone: 203-574-9000
  • Fax: 203-574-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number013
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3694
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: