=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871356477
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. NICOLE MURN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2024
-----------------------------------------------------
Last Update Date | 02/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 SCHOOL LN
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11743-1039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-367-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 OLD FIELD RD
-----------------------------------------------------
City | CENTERPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11721-1727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-312-6377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------