Healthcare Provider Details

I. General information

NPI: 1538210489
Provider Name (Legal Business Name): DR. JOHN D HURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PARK PLZ SUITE 608
BOSTON MA
02116-4303
US

IV. Provider business mailing address

31 OTIS HILL RD
NORWELL MA
02061-1217
US

V. Phone/Fax

Practice location:
  • Phone: 617-335-5475
  • Fax:
Mailing address:
  • Phone: 781-659-7024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number917
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: