Provider Demographics
NPI:1710036066
Name:MURRAY, JENNIFER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2860
Mailing Address - Country:US
Mailing Address - Phone:203-410-6636
Mailing Address - Fax:203-250-0007
Practice Address - Street 1:416 HIGHLAND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2527
Practice Address - Country:US
Practice Address - Phone:203-410-6636
Practice Address - Fax:203-250-0007
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002147103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT185764OtherMHN
CT114894OtherABH
CT163023OtherVALUEOPTIONS