Healthcare Provider Details

I. General information

NPI: 1174077846
Provider Name (Legal Business Name): SARA L HURLBURT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7513 COURT STREET
ELIZABETHTOWN NY
12932-0008
US

IV. Provider business mailing address

PO BOX 8
ELIZABETHTOWN NY
12932-0008
US

V. Phone/Fax

Practice location:
  • Phone: 518-873-3670
  • Fax: 518-873-3777
Mailing address:
  • Phone: 518-873-3670
  • Fax: 518-873-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number092758-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089660-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: