Provider Demographics
NPI:1447566625
Name:MURPHY, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 N WOLCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1019
Mailing Address - Country:US
Mailing Address - Phone:847-894-1354
Mailing Address - Fax:
Practice Address - Street 1:3000 DUNDEE RD
Practice Address - Street 2:SUITE 311
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2422
Practice Address - Country:US
Practice Address - Phone:847-894-1354
Practice Address - Fax:847-383-6976
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008507101YP2500X
IL180009879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional