Provider Demographics
NPI:1205937414
Name:MURRAY, CAROL ANNE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MIRONA ROAD EXT
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5343
Mailing Address - Country:US
Mailing Address - Phone:603-422-8836
Mailing Address - Fax:603-766-3141
Practice Address - Street 1:30 MIRONA ROAD EXT
Practice Address - Street 2:SUITE 3
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5343
Practice Address - Country:US
Practice Address - Phone:603-422-8836
Practice Address - Fax:603-766-3141
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1408234Y0NH01OtherANTHEM BC/BS
NH30421633Medicaid
ME061685OtherANTHEM BC/BS
NH30421633Medicaid