Healthcare Provider Details

I. General information

NPI: 1306219134
Provider Name (Legal Business Name): CHE RAQUEL HURT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 41ST ST
WEST PALM BEACH FL
33407-4128
US

IV. Provider business mailing address

504 US HIGHWAY 70 W # 145
HAVELOCK NC
28532-9510
US

V. Phone/Fax

Practice location:
  • Phone: 561-846-0674
  • Fax:
Mailing address:
  • Phone: 561-846-0674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10174
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: