Provider Demographics
NPI:1174928071
Name:MURPHY, LOGAN (LSW)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:MURPHY
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:LOGAN
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:1351 FAIRVIEW BLVD
Mailing Address - Street 2:SUITE A #1089
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075
Mailing Address - Country:US
Mailing Address - Phone:856-912-0712
Mailing Address - Fax:
Practice Address - Street 1:1351 FAIRVIEW BLVD
Practice Address - Street 2:SUITE A #1089
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075
Practice Address - Country:US
Practice Address - Phone:856-912-0712
Practice Address - Fax:856-245-8388
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171M00000X
NJ44SL05995500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator