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General NPI Number Information
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NPI Number | 1417312976
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Entity Type | Individual
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Provider Name | MARY KATHERINE MURRAY LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 12200 E 13 MILE RD 200
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City | WARREN
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State | MI
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Zip | 48093-3093
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Country | US
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Telephone | 586-258-0206
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Fax |
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Provider Business Mailing Address
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Address Line | 38350 CHARTIER ST
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City | HARRISON TOWNSHIP
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State | MI
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Zip | 48045-3412
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Country | US
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Telephone | 586-899-4810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801105975
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License Number State | MI
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