Healthcare Provider Details

I. General information

NPI: 1033256979
Provider Name (Legal Business Name): KEVIN EDWARD MURPHY M.A,C.A.G.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 CHANDLER ST
WORCESTER MA
01602-3441
US

IV. Provider business mailing address

19 D MILLLERS WAY
SUTTON MA
01590
US

V. Phone/Fax

Practice location:
  • Phone: 508-767-3045
  • Fax: 508-453-2450
Mailing address:
  • Phone: 508-767-3045
  • Fax: 508-453-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3300
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: