Healthcare Provider Details

I. General information

NPI: 1255588646
Provider Name (Legal Business Name): MAUREEN MURPHY HERNANDES LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAUREEN MURPHY HERNANDES LCSW-R

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 LIMERIDGE ROAD
POUGHQUAG NY
12570-1328
US

IV. Provider business mailing address

144 LIME RIDGE RD
POUGHQUAG NY
12570-5422
US

V. Phone/Fax

Practice location:
  • Phone: 845-489-2651
  • Fax: 485-489-2651
Mailing address:
  • Phone: 845-489-2651
  • Fax: 485-489-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069655
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: