Healthcare Provider Details

I. General information

NPI: 1326580036
Provider Name (Legal Business Name): JANIS HURLEY R.N., L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LAKEVIEW CT
EASTPORT NY
11941-1208
US

IV. Provider business mailing address

8 LAKEVIEW CT
EASTPORT NY
11941-1208
US

V. Phone/Fax

Practice location:
  • Phone: 631-553-5371
  • Fax:
Mailing address:
  • Phone: 631-553-5371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number045277
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: