Healthcare Provider Details

I. General information

NPI: 1699263863
Provider Name (Legal Business Name): WENDY HURWITZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 MAIN ST
WALTHAM MA
02451-1623
US

IV. Provider business mailing address

1430 MAIN ST
WALTHAM MA
02451-1623
US

V. Phone/Fax

Practice location:
  • Phone: 781-693-5623
  • Fax:
Mailing address:
  • Phone: 781-693-5623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10045
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: