Provider Demographics
NPI:1295956142
Name:MURPHY, SEAN D (LADAC)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:D
Last Name:MURPHY
Suffix:
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 MANZANO LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-7545
Mailing Address - Country:US
Mailing Address - Phone:505-867-7452
Mailing Address - Fax:
Practice Address - Street 1:3901 GEORGIA NE
Practice Address - Street 2:SUITE C-3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3615
Practice Address - Country:US
Practice Address - Phone:505-217-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0078061101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)