Provider Demographics
NPI:1073195095
Name:MURPHY, JAQUAYA MONAE (LLBSW, LLMSW)
Entity type:Individual
Prefix:
First Name:JAQUAYA
Middle Name:MONAE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:LLBSW, LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9288
Mailing Address - Country:US
Mailing Address - Phone:989-673-6191
Mailing Address - Fax:
Practice Address - Street 1:1332 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9288
Practice Address - Country:US
Practice Address - Phone:989-673-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X
171M00000X
MI6851118441104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator