Healthcare Provider Details

I. General information

NPI: 1134508823
Provider Name (Legal Business Name): JULIE HURLEY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 MAIN ST
SOUTHBRIDGE MA
01550-3794
US

IV. Provider business mailing address

328 MAIN ST
SOUTHBRIDGE MA
01550-3794
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-9101
  • Fax: 508-764-4389
Mailing address:
  • Phone: 508-765-9101
  • Fax: 508-764-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: