Healthcare Provider Details

I. General information

NPI: 1255052304
Provider Name (Legal Business Name): RICARDO HURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 S ARLINGTON HEIGHTS RD STE 116
ARLINGTON HEIGHTS IL
60005-4142
US

IV. Provider business mailing address

2101 S ARLINGTON ROAD SUITE 116
ARLINGTON HEIGHTS IL
60005
US

V. Phone/Fax

Practice location:
  • Phone: 847-666-5339
  • Fax:
Mailing address:
  • Phone: 847-666-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: