Healthcare Provider Details

I. General information

NPI: 1891233003
Provider Name (Legal Business Name): THOMAS D MURRAY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 PRITHAM AVE
FRENCHTOWN TWP ME
04441-7214
US

IV. Provider business mailing address

PO BOX 1129
GREENVILLE ME
04441-1129
US

V. Phone/Fax

Practice location:
  • Phone: 207-695-5220
  • Fax: 207-695-5234
Mailing address:
  • Phone: 207-695-5210
  • Fax: 207-695-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC4354
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: