Provider Demographics
NPI:1780390187
Name:MURPHY, MELISSA ANNE (LMSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 PEACHTREE CT
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2536
Mailing Address - Country:US
Mailing Address - Phone:631-525-7459
Mailing Address - Fax:
Practice Address - Street 1:606 JOHNSON AVE STE 30
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2688
Practice Address - Country:US
Practice Address - Phone:631-509-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116376104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker