Active NPI
Kim Hurley, LCSW
- Clinical Social Worker
- Fontana, CA
National Provider Identifier
1962738740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 19301
- Practice address
- 7585 Yellow Iris CT
Fontana, CA 92336-0729 - Phone
- (909) 823-2124
- NPI assigned
- Oct 28, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 19301 | CA | Primary |
Addresses
Primary practice location
7585 Yellow Iris CT
Fontana, CA 92336-0729
Mailing address
7426 Cherry Ave Ste 412
Fontana, CA 92336-4221
Phone (626) 808-3433
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6786789 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19301 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289174400000",
"number": "1962738740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7426 CHERRY AVE STE 412",
"city": "FONTANA",
"state": "CA",
"postal_code": "923364221",
"telephone_number": "626-808-3433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7585 YELLOW IRIS CT",
"city": "FONTANA",
"state": "CA",
"postal_code": "923360729",
"telephone_number": "909-823-2124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HURLEY",
"first_name": "KIM",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-10-28",
"last_updated": "2010-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "19301",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6786789",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fontana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.