Provider Demographics
NPI:1194352435
Name:HURLOCK, KATHERINE (BCBS)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HURLOCK
Suffix:
Gender:F
Credentials:BCBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3220
Mailing Address - Country:US
Mailing Address - Phone:844-234-8387
Mailing Address - Fax:856-429-4755
Practice Address - Street 1:104 RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1149
Practice Address - Country:US
Practice Address - Phone:844-234-8387
Practice Address - Fax:856-429-4755
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst