Provider Demographics
NPI:1275025959
Name:HURLEY, MARY WALSH (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:WALSH
Last Name:HURLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:59 ELIOT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1708
Mailing Address - Country:US
Mailing Address - Phone:617-552-8973
Mailing Address - Fax:
Practice Address - Street 1:59 ELIOT AVE
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-1708
Practice Address - Country:US
Practice Address - Phone:617-552-8973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1168-PY-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1168-PY-PROtherMA BOARD OF REGISTRATION IN PSYCHOLOGY