Basic Information
| Provider Information | |||||||||
| NPI: | 1740551217 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | ALISSA | ||||||||
| MiddleName: | BRAE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 78 FERONIA WAY | ||||||||
| Address2: | |||||||||
| City: | RUTHERFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070702102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016152366 | ||||||||
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| Practice Location | |||||||||
| Address1: | 176 PALISADE AVE | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073061121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017958200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2012 | ||||||||
| LastUpdateDate: | 01/15/2012 | ||||||||
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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 | 1041C0700X | 44SC05487900 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.