Provider Demographics
NPI:1972623221
Name:HARDY, MAURICE (LSW)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:HARDY
Suffix:
Gender:M
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:ND
Mailing Address - Zip Code:58577-0070
Mailing Address - Country:US
Mailing Address - Phone:701-462-3581
Mailing Address - Fax:701-462-3590
Practice Address - Street 1:712 5TH AVE
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:ND
Practice Address - Zip Code:58577-4352
Practice Address - Country:US
Practice Address - Phone:701-462-3581
Practice Address - Fax:701-462-3590
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2259104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND27488OtherBS OF ND
ND74024Medicaid