Provider Demographics
NPI:1326580036
Name:HURLEY, JANIS (RN, LMSW)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:HURLEY
Suffix:
Gender:F
Credentials:RN, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11941-1208
Mailing Address - Country:US
Mailing Address - Phone:631-553-5371
Mailing Address - Fax:
Practice Address - Street 1:8 LAKEVIEW CT
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:NY
Practice Address - Zip Code:11941-1208
Practice Address - Country:US
Practice Address - Phone:631-553-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0452771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNE3521Medicare PIN