Healthcare Provider Details

I. General information

NPI: 1043687841
Provider Name (Legal Business Name): COURTNI ELIZABETH HURD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date: 06/02/2016
Reactivation Date: 03/30/2023

III. Provider practice location address

PO BOX 1357
PITTSFORD NY
14534-8357
US

IV. Provider business mailing address

PO BOX 1357
PITTSFORD NY
14534-8357
US

V. Phone/Fax

Practice location:
  • Phone: 917-972-9237
  • Fax:
Mailing address:
  • Phone: 315-288-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number086211
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130473513501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: