1417063967 NPI number — MICHELLE ANNETTE MURRAY L.M.H.C

Table of content: MICHELLE ANNETTE MURRAY L.M.H.C (NPI 1417063967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417063967 NPI number — MICHELLE ANNETTE MURRAY L.M.H.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURRAY
Provider First Name:
MICHELLE
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.M.H.C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIFER
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
ANNETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.C.S.W
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417063967
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:
149 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
E LONGMEADOW
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01028-1264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-525-5811
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 MYSTIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02155-4632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-396-1199
Provider Business Practice Location Address Fax Number:
781-396-1439
Provider Enumeration Date:
08/21/2006

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:  432 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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