Provider Demographics
NPI:1336386895
Name:HULBURT, JEREMIAH (LCSW)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:HULBURT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 E 121ST ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3523
Mailing Address - Country:US
Mailing Address - Phone:212-801-3300
Mailing Address - Fax:
Practice Address - Street 1:198 E 121ST ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3523
Practice Address - Country:US
Practice Address - Phone:212-801-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0805021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical