Provider Demographics
NPI:1902027170
Name:MURPHY, MARY GERALDINE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:GERALDINE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SECOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3011
Mailing Address - Country:US
Mailing Address - Phone:631-234-9856
Mailing Address - Fax:
Practice Address - Street 1:19 SECOND AVENUE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-3011
Practice Address - Country:US
Practice Address - Phone:631-234-9856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO213941104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
N25581Medicare ID - Type Unspecified