Healthcare Provider Details

I. General information

NPI: 1689056749
Provider Name (Legal Business Name): JACQUI HURWITZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 KNIGHT AVE
RUNNEMEDE NJ
08078-1744
US

IV. Provider business mailing address

80 KNIGHT AVE
RUNNEMEDE NJ
08078-1744
US

V. Phone/Fax

Practice location:
  • Phone: 856-217-0258
  • Fax:
Mailing address:
  • Phone: 856-217-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberNJ37PC00647200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00230600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: