Provider Demographics
NPI:1811911621
Name:MURPHY, GRACE (MSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:SHADY
Mailing Address - State:NY
Mailing Address - Zip Code:12409-0269
Mailing Address - Country:US
Mailing Address - Phone:845-679-6181
Mailing Address - Fax:
Practice Address - Street 1:404 ZENA RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-2626
Practice Address - Country:US
Practice Address - Phone:845-679-8650
Practice Address - Fax:845-679-5485
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR023206-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY138142OtherVALUE OPTIONS
NY991997OtherMVP
NY7192077OtherAETNA
NY0102965OtherGHI
NYN7106Medicare ID - Type Unspecified