Provider Demographics
NPI:1619125309
Name:MURRAY-HALL, JEANETTE (MS)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:MURRAY-HALL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 W LAKE RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16134-3533
Mailing Address - Country:US
Mailing Address - Phone:724-815-5836
Mailing Address - Fax:
Practice Address - Street 1:10 SNYDER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3432
Practice Address - Country:US
Practice Address - Phone:724-815-5836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005127101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100000380 CCC'S #Medicaid