Provider Demographics
NPI:1043876188
Name:HURLEY, CAROL ANNE (MSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:HURLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 AMESBURY ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4209
Mailing Address - Country:US
Mailing Address - Phone:203-461-0840
Mailing Address - Fax:
Practice Address - Street 1:15 AMESBURY ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4209
Practice Address - Country:US
Practice Address - Phone:203-461-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPENDING1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2997OtherLICENSED CLINICAL SOCIAL WORKER