Provider Demographics
NPI:1215760780
Name:MURPHY, SHANNON L (MHC-LP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HARRISON AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3963
Mailing Address - Country:US
Mailing Address - Phone:516-859-5942
Mailing Address - Fax:
Practice Address - Street 1:108 S FRANKLIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-6105
Practice Address - Country:US
Practice Address - Phone:516-303-9925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P130224-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health