MEDICARE: DR. MARILYN HENRY MURPHY ED.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY3160	CA

General Provider Information

NPI Number	:	1093074999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN HENRY MURPHY ED.D.

Provider Business Mailing Address
First Line	:	1158 26TH ST.
Second Line	:	# 669
City	:	SANTA MONICA
State	:	CA
Zip	:	90403
Country	:	US
Telephone Number	:	310-310-0767
Fax Number	:

Provider Business Practice Location Address
First Line	:	4368 EAGLE ROCK BOULEVARD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041
Country	:	US
Telephone Number	:	314-843-0043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	10/25/2012

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