Healthcare Provider Details

I. General information

NPI: 1790166114
Provider Name (Legal Business Name): MURPHY COMARDELLE III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SAINT CHARLES AVE STE 2500
NEW ORLEANS LA
70170-2500
US

IV. Provider business mailing address

500 FAIRWAY DR SUITE 102
DEERFIELD BEACH FL
33441-1814
US

V. Phone/Fax

Practice location:
  • Phone: 855-550-5308
  • Fax:
Mailing address:
  • Phone: 888-880-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: