Healthcare Provider Details

I. General information

NPI: 1356341804
Provider Name (Legal Business Name): HOLLIE HUREWITZ MACP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 S UNION ST APT 2
BURLINGTON VT
05401-5918
US

IV. Provider business mailing address

470 S UNION ST APT 2
BURLINGTON VT
05401-5918
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-3842
  • Fax:
Mailing address:
  • Phone: 802-658-3842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number047-0000525
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: