Healthcare Provider Details

I. General information

NPI: 1083786560
Provider Name (Legal Business Name): PATRICIA HURLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 GLEBE AVE
BRONX NY
10461-3109
US

IV. Provider business mailing address

2527 GLEBE AVE
BRONX NY
10461-3109
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-4400
  • Fax: 718-931-7307
Mailing address:
  • Phone: 718-904-4400
  • Fax: 718-931-7307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074991-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: