Provider Demographics
NPI:1871794511
Name:HURD, MARY MICHELE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MICHELE
Last Name:HURD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:HURD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:200 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-5040
Mailing Address - Country:US
Mailing Address - Phone:717-272-5464
Mailing Address - Fax:717-273-1416
Practice Address - Street 1:75 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2224
Practice Address - Country:US
Practice Address - Phone:717-262-4969
Practice Address - Fax:717-263-1647
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0127871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103422276Medicaid