Provider Demographics
NPI:1437499175
Name:MURPHY, KELLI JO (LCSW, RN)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:JO
Last Name:MURPHY
Suffix:
Gender:F
Credentials:LCSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 WAYSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15210-4154
Mailing Address - Country:US
Mailing Address - Phone:570-220-9347
Mailing Address - Fax:
Practice Address - Street 1:516 WAYSIDE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15210-4154
Practice Address - Country:US
Practice Address - Phone:570-220-9347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-17
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0175721041C0700X
PARN500131L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse