Healthcare Provider Details

I. General information

NPI: 1871794511
Provider Name (Legal Business Name): MARY MICHELE HURD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELE HURD LCSW

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S MAIN ST
CHAMBERSBURG PA
17201-2224
US

IV. Provider business mailing address

200 N 7TH ST
LEBANON PA
17046-5040
US

V. Phone/Fax

Practice location:
  • Phone: 717-262-4969
  • Fax: 717-263-1647
Mailing address:
  • Phone: 717-272-5464
  • Fax: 717-273-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW012787
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: