Healthcare Provider Details

I. General information

NPI: 1346686011
Provider Name (Legal Business Name): GLENN A HURWITZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 06/11/2023
Certification Date: 06/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3961 HILLMAN AVE
BRONX NY
10463-3001
US

IV. Provider business mailing address

500 RIVERDALE AVE APT. 6F
YONKERS NY
10705-3564
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-9200
  • Fax:
Mailing address:
  • Phone: 914-965-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089149
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: