Provider Demographics
NPI:1780628230
Name:MURRAY, CAROL M (LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:MURRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 MONONA DR
Mailing Address - Street 2:SUITE 314 MONONA MEDIATION & COUNSELING
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3952
Mailing Address - Country:US
Mailing Address - Phone:608-442-3420
Mailing Address - Fax:608-442-3421
Practice Address - Street 1:6320 MONONA DR
Practice Address - Street 2:SUITE 314 MONONA MEDIATION & COUNSELING
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3952
Practice Address - Country:US
Practice Address - Phone:608-442-3420
Practice Address - Fax:608-442-3421
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI913-1231041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39651900Medicaid
R76578Medicare UPIN