Provider Demographics
NPI:1154949071
Name:HURST, RYAN (LCSW)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:HURST
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 1:14021 32ND AVE APT 1AS
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2614
Mailing Address - Country:US
Mailing Address - Phone:347-206-5063
Mailing Address - Fax:
Practice Address - Street 1:14021 32ND AVE APT 1AS
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2614
Practice Address - Country:US
Practice Address - Phone:646-262-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104446-1101YM0800X
NY0927981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health