=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295209658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOAN MURPHY LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2019
-----------------------------------------------------
Last Update Date | 01/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 61 CHARLES ST
-----------------------------------------------------
City | NATICK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01760-2832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-254-0287
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 863 CENTRAL ST
-----------------------------------------------------
City | FRAMINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01701-4892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-879-8000
-----------------------------------------------------
Fax | 508-626-1604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 115826
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------