Basic Information
| Provider Information | |||||||||
| NPI: | 1124453451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | MARGO | ||||||||
| MiddleName: | MERRYMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 LAFAYETTE AVE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112161020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184759407 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 LAFAYETTE AVE | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112161020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184759407 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2013 | ||||||||
| LastUpdateDate: | 09/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 03505424 | 05 | NY | MEDICAID |