Healthcare Provider Details

I. General information

NPI: 1972830487
Provider Name (Legal Business Name): LYNNE HURLBUT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1794 PENFIELD RD
PENFIELD NY
14526-2124
US

IV. Provider business mailing address

490 E RIDGE RD
ROCHESTER NY
14621-1229
US

V. Phone/Fax

Practice location:
  • Phone: 585-789-1457
  • Fax:
Mailing address:
  • Phone: 585-922-2633
  • Fax: 585-922-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number077106-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number082611
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: