Provider Demographics
NPI:1376628255
Name:MURPHY, DAVID JOHN (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:MURPHY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 GRAVENSTEIN AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4555
Mailing Address - Country:US
Mailing Address - Phone:707-566-7026
Mailing Address - Fax:707-566-7026
Practice Address - Street 1:874 GRAVENSTEIN AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4555
Practice Address - Country:US
Practice Address - Phone:707-566-7026
Practice Address - Fax:707-566-7026
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15671103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP66984Medicare UPIN