Provider Demographics
NPI:1962916072
Name:HURTT, KIMBERLY BETH (LSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BETH
Last Name:HURTT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 SUPERIOR AVE E STE 400
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114
Practice Address - Country:US
Practice Address - Phone:216-357-2621
Practice Address - Fax:216-357-2625
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1000774104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS.1000774OtherOHIO BOARD OF SOCIAL WORKER, MARRIAGE AND FAMILY COUNSELING
OH1962916072Medicaid