MEDICARE: MS. TANISHA MURRAY PHD STUDENT, MSW

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	1041C0700X	Clinical Social Worker	0906010798	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1881308344	OTHER	VA	BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1225742869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANISHA MURRAY PHD STUDENT, MSW

Provider Business Mailing Address
First Line	:	5101 OLD MAIN ST APT 309
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23231-3011
Country	:	US
Telephone Number	:	804-302-7434
Fax Number	:	208-823-1520

Provider Business Practice Location Address
First Line	:	5101 OLD MAIN ST APT 309
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23231-3011
Country	:	US
Telephone Number	:	804-302-7434
Fax Number	:	208-823-1520

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

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	09/05/2023

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