Provider Demographics
NPI:1417153479
Name:HURST, CHERYL L (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:L
Last Name:HURST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 E 199TH ST
Mailing Address - Street 2:APT. 1G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1715
Mailing Address - Country:US
Mailing Address - Phone:347-524-0202
Mailing Address - Fax:718-584-5314
Practice Address - Street 1:2502 LORILLARD PL
Practice Address - Street 2:RM. B31
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5997
Practice Address - Country:US
Practice Address - Phone:718-295-4563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065392104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker