Healthcare Provider Details

I. General information

NPI: 1811216641
Provider Name (Legal Business Name): STACY LYNN HURLEY MSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DUNMANWAY
DUNDALK MD
21222-5115
US

IV. Provider business mailing address

3200 GREEN HILL RD
EDGEMERE MD
21219-1104
US

V. Phone/Fax

Practice location:
  • Phone: 410-285-4357
  • Fax: 410-285-4361
Mailing address:
  • Phone: 410-733-1516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12340
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: