Provider Demographics
NPI:1972079077
Name:MURRAY, KEVIN (DSW, LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MURRAY
Suffix:
Gender:M
Credentials:DSW, LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2828
Mailing Address - Country:US
Mailing Address - Phone:203-927-8407
Mailing Address - Fax:
Practice Address - Street 1:406 S UNION ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2828
Practice Address - Country:US
Practice Address - Phone:203-927-8407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11616101YM0800X
CT001307101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008022626Medicaid
CT008056168Medicaid
CT004082286Medicaid
CT008083643Medicaid
CT500000315Medicaid