Healthcare Provider Details

I. General information

NPI: 1831610112
Provider Name (Legal Business Name): SEAN BARRY MURPHY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23346 W LIBERTY AVE
LAKE VILLA IL
60046-8763
US

IV. Provider business mailing address

3957 W IRVING PARK RD APT 204
CHICAGO IL
60618-3130
US

V. Phone/Fax

Practice location:
  • Phone: 847-903-5604
  • Fax:
Mailing address:
  • Phone: 224-733-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.019394
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: