Provider Demographics
NPI:1417312976
Name:MURRAY, MARY KATHERINE (LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38350 CHARTIER ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-3412
Mailing Address - Country:US
Mailing Address - Phone:586-899-4810
Mailing Address - Fax:
Practice Address - Street 1:12200 E 13 MILE RD
Practice Address - Street 2:200
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3093
Practice Address - Country:US
Practice Address - Phone:586-258-0206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011059751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical