Provider Demographics
NPI:1790913341
Name:MURPHY, KAYLEE DODGE (LICSW)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:DODGE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2505
Mailing Address - Country:US
Mailing Address - Phone:855-237-2889
Mailing Address - Fax:855-237-2889
Practice Address - Street 1:17 POPLAR ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2505
Practice Address - Country:US
Practice Address - Phone:855-237-2889
Practice Address - Fax:855-237-2889
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1151901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical