Provider Demographics
NPI:1174902720
Name:MURPHY, MARY (SPECIAL EDUCATION)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WINTHROP DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1739
Mailing Address - Country:US
Mailing Address - Phone:607-351-0396
Mailing Address - Fax:
Practice Address - Street 1:402 WINTHROP DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1739
Practice Address - Country:US
Practice Address - Phone:607-351-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY665107061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22426OtherEARLY INTERVENTION PROVIDER NUMBER