Healthcare Provider Details

I. General information

NPI: 1285932830
Provider Name (Legal Business Name): MARY M. HURWITZ LMHC, M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CLOUTMANS LN
MARBLEHEAD MA
01945-1504
US

IV. Provider business mailing address

22 CLOUTMANS LN
MARBLEHEAD MA
01945-1504
US

V. Phone/Fax

Practice location:
  • Phone: 781-640-9246
  • Fax: 253-498-1127
Mailing address:
  • Phone: 781-640-9246
  • Fax: 253-498-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3676
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: