Provider Demographics
NPI:1194749481
Name:HURD, MICHAEL J (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:HURD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-5554
Mailing Address - Country:US
Mailing Address - Phone:302-539-5986
Mailing Address - Fax:410-997-2805
Practice Address - Street 1:17 ATLANTIC AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:OCEAN VIEW
Practice Address - State:DE
Practice Address - Zip Code:19970-9115
Practice Address - Country:US
Practice Address - Phone:302-539-5986
Practice Address - Fax:410-997-2805
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00007291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02078L01Medicare PIN