Healthcare Provider Details

I. General information

NPI: 1225383821
Provider Name (Legal Business Name): DR. TERESA HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AMSTERDAM AVE CLARK 6TH FLOOR
NEW YORK NY
10025-1716
US

IV. Provider business mailing address

1111 AMSTERDAM AVE CLARK 6TH FLOOR
NEW YORK NY
10025-1716
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-6500
  • Fax: 212-523-5677
Mailing address:
  • Phone: 212-523-6500
  • Fax: 212-523-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number019643
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019643
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: