Healthcare Provider Details

I. General information

NPI: 1447998448
Provider Name (Legal Business Name): RACHEL M HURLEY LSW, MED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 N 44TH ST
PHILADELPHIA PA
19104-1362
US

IV. Provider business mailing address

766 N 44TH ST
PHILADELPHIA PA
19104-1362
US

V. Phone/Fax

Practice location:
  • Phone: 484-278-3814
  • Fax:
Mailing address:
  • Phone: 484-278-3814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW131987
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: