Provider Demographics
NPI:1487722401
Name:MURPHY, JENNIFER MARY (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARY
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 LAWTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3156
Mailing Address - Country:US
Mailing Address - Phone:415-290-6004
Mailing Address - Fax:415-373-3752
Practice Address - Street 1:1559B SLOAT BLVD
Practice Address - Street 2:#151
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1222
Practice Address - Country:US
Practice Address - Phone:415-290-6004
Practice Address - Fax:415-373-3752
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18403103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY18403OtherPSYCHOLOGIST LICENSE NO.
CAOPL184031Medicare UPIN