Healthcare Provider Details

I. General information

NPI: 1316037625
Provider Name (Legal Business Name): EDWARD D HURLEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 ADAMS ST
BURLINGTON VT
05401-4525
US

IV. Provider business mailing address

92 ADAMS ST
BURLINGTON VT
05401-4525
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-0781
  • Fax:
Mailing address:
  • Phone: 802-864-0781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number048-0000219
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: