Provider Demographics
NPI:1316137029
Name:HURSTER, THOMAS KELLY (LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:KELLY
Last Name:HURSTER
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 1:26 SUMMIT GROVE AVE
Mailing Address - Street 2:SUITE #213
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3230
Mailing Address - Country:US
Mailing Address - Phone:610-525-5030
Mailing Address - Fax:
Practice Address - Street 1:26 SUMMIT GROVE AVE
Practice Address - Street 2:SUITE #213
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3230
Practice Address - Country:US
Practice Address - Phone:610-525-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-29
Last Update Date:2007-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-002189-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical