Healthcare Provider Details

I. General information

NPI: 1780623017
Provider Name (Legal Business Name): LESLIE MURPHY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 QUEEN STREET, GROUND FLOOR UMASS MEMORIAL MED CTR, AMBULATORY PSYCHIATRY SERVICE
WORCESTER MA
01610
US

IV. Provider business mailing address

26 QUEEN STREET, GROUND FLOOR UMASS MEMORIAL MED CTR, AMBULATORY PSYCHIATRY SERVICE
WORCESTER MA
01610
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-2537
  • Fax: 508-334-4320
Mailing address:
  • Phone: 508-334-2537
  • Fax: 508-334-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1019409
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: