Healthcare Provider Details

I. General information

NPI: 1972079077
Provider Name (Legal Business Name): KEVIN MURRAY DSW, LCSW, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S UNION ST
GUILFORD CT
06437-2828
US

IV. Provider business mailing address

406 S UNION ST
GUILFORD CT
06437-2828
US

V. Phone/Fax

Practice location:
  • Phone: 203-927-8407
  • Fax:
Mailing address:
  • Phone: 203-927-8407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001307
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11616
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: