Provider Demographics
NPI:1184953291
Name:MURRAY, MICHELLE KATHLEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:KATHLEEN
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-9208
Mailing Address - Country:US
Mailing Address - Phone:585-593-6084
Mailing Address - Fax:
Practice Address - Street 1:85 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1254
Practice Address - Country:US
Practice Address - Phone:585-610-5248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000766-1106H00000X
PAMF000296106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist