Provider Demographics
NPI:1013262831
Name:HURST, LORY ANN (CSW)
Entity Type:Individual
Prefix:
First Name:LORY
Middle Name:ANN
Last Name:HURST
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MRS
Other - First Name:LORY
Other - Middle Name:ANN
Other - Last Name:OCONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:14582 225TH ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3520
Mailing Address - Country:US
Mailing Address - Phone:718-528-9091
Mailing Address - Fax:
Practice Address - Street 1:14582 225TH ST
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-3520
Practice Address - Country:US
Practice Address - Phone:718-528-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068312-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool