Provider Demographics
NPI:1174348429
Name:MURRAY, WANDA J (MHC-LIMITED PERMIT)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:J
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MHC-LIMITED PERMIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12421 FLATLANDS AVE APT 8J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-5811
Mailing Address - Country:US
Mailing Address - Phone:347-674-9715
Mailing Address - Fax:
Practice Address - Street 1:12421 FLATLANDS AVE APT 8J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-5811
Practice Address - Country:US
Practice Address - Phone:917-500-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-12-20
Deactivation Date:2024-11-21
Deactivation Code:
Reactivation Date:2024-12-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health