Provider Demographics
NPI:1801153044
Name:MURPHY, SUSAN JEAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S INDIAN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4343
Mailing Address - Country:US
Mailing Address - Phone:772-340-5750
Mailing Address - Fax:
Practice Address - Street 1:130 S INDIAN RIVER DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4343
Practice Address - Country:US
Practice Address - Phone:772-340-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health