Healthcare Provider Details

I. General information

NPI: 1417153479
Provider Name (Legal Business Name): CHERYL L HURST LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 LORILLARD PL RM. B31
BRONX NY
10458-5997
US

IV. Provider business mailing address

18 E 199TH ST APT. 1G
BRONX NY
10468-1715
US

V. Phone/Fax

Practice location:
  • Phone: 718-295-4563
  • Fax:
Mailing address:
  • Phone: 347-524-0202
  • Fax: 718-584-5314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number065392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: