Provider Demographics
NPI:1336208339
Name:MURPHY, BRET DEAN (MA)
Entity Type:Individual
Prefix:MR
First Name:BRET
Middle Name:DEAN
Last Name:MURPHY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3656
Mailing Address - Country:US
Mailing Address - Phone:336-333-6853
Mailing Address - Fax:336-333-6815
Practice Address - Street 1:301 E. WASHINGTON STREET YOUTH FOCUS
Practice Address - Street 2:SUITE 301
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2957
Practice Address - Country:US
Practice Address - Phone:336-333-6853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1691103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107269Medicaid