Basic Information
| Provider Information | |||||||||
| NPI: | 1124210174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | PRATICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 780 WILLARD ST | ||||||||
| Address2: | U-CZ | ||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021697461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815883262 | ||||||||
| FaxNumber: | 5085834649 | ||||||||
| Practice Location | |||||||||
| Address1: | 157 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023014012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085596699 | ||||||||
| FaxNumber: | 5085834649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 08/14/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 410781 | MA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.