Provider Demographics
NPI:1831610112
Name:MURPHY, SEAN BARRY
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:BARRY
Last Name:MURPHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 W IRVING PARK RD APT 204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3130
Mailing Address - Country:US
Mailing Address - Phone:224-733-3165
Mailing Address - Fax:
Practice Address - Street 1:23346 W LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8763
Practice Address - Country:US
Practice Address - Phone:847-903-5604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0193941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical