Healthcare Provider Details

I. General information

NPI: 1588736201
Provider Name (Legal Business Name): TONILLE HURLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41-36 27TH STREET STEINWAY CHILD AND FAMILY SERVICES
LONG ISLAND CITY NY
11101
US

IV. Provider business mailing address

41 36 27TH STREET STEINWAY CHILD AND FAMILY SERVICES
LONG ISLAND CITY NY
11101
US

V. Phone/Fax

Practice location:
  • Phone: 718-389-5100
  • Fax: 718-391-9665
Mailing address:
  • Phone: 718-389-5100
  • Fax: 718-391-9665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number067873
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: