1073635728 NPI number — RUTH L MURRAY LCMHC

Table of content: RUTH L MURRAY LCMHC (NPI 1073635728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073635728 NPI number — RUTH L MURRAY LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURRAY
Provider First Name:
RUTH
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073635728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 MYRTLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03104-4354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-668-0014
Provider Business Mailing Address Fax Number:
603-623-7676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 GILFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LACONIA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03246-2827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-528-3035
Provider Business Practice Location Address Fax Number:
603-524-7153
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  150 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1047072 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 14Y000881NH01 . This is a "WELLPOINT BHN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 5395900 . This is a "UBH PACIFICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 11656407 . This is a "CAQH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30009753 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1011854 . This is a "VT MEDICAID" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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