Healthcare Provider Details

I. General information

NPI: 1962916072
Provider Name (Legal Business Name): KIMBERLY BETH HURTT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SUPERIOR AVE E STE 400
CLEVELAND OH
44114
US

IV. Provider business mailing address

3100 E 45TH ST
CLEVELAND OH
44127-1088
US

V. Phone/Fax

Practice location:
  • Phone: 216-357-2621
  • Fax: 216-357-2625
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1000774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: