Provider Demographics
NPI:1699973974
Name:HURWITZ, HOLLY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:HURWITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 NE ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2668
Mailing Address - Country:US
Mailing Address - Phone:503-231-8371
Mailing Address - Fax:
Practice Address - Street 1:1525 NE WEIDLER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1410
Practice Address - Country:US
Practice Address - Phone:503-215-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL002699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health