Healthcare Provider Details

I. General information

NPI: 1760500292
Provider Name (Legal Business Name): GERALDINE CLARE HURLEY LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH ST
PITTSFIELD MA
01201-4109
US

IV. Provider business mailing address

PO BOX 516
HOUSATONIC MA
01236-0516
US

V. Phone/Fax

Practice location:
  • Phone: 413-447-3065
  • Fax:
Mailing address:
  • Phone: 413-274-6127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number156871
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: