Healthcare Provider Details

I. General information

NPI: 1881210003
Provider Name (Legal Business Name): HURLEY SOCIAL WORK SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GREEN HILL RD
EDGEMERE MD
21219-1104
US

IV. Provider business mailing address

3200 GREEN HILL RD
EDGEMERE MD
21219-1104
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. STACY LYNN HURLEY
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW, LCSW-C
Phone: 410-733-1516