Healthcare Provider Details

I. General information

NPI: 1093074999
Provider Name (Legal Business Name): MARILYN HENRY MURPHY ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 EAGLE ROCK BOULEVARD
LOS ANGELES CA
90041
US

IV. Provider business mailing address

1158 26TH ST. # 669
SANTA MONICA CA
90403
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-0043
  • Fax:
Mailing address:
  • Phone: 310-310-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY3160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: