Provider Demographics
NPI:1720821044
Name:MURRAY, SAMUEL JOSEPH JR
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:MURRAY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 W GRAND BLVD APT 5101
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2684
Mailing Address - Country:US
Mailing Address - Phone:336-350-2454
Mailing Address - Fax:
Practice Address - Street 1:2911 W GRAND BLVD APT 5101
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2684
Practice Address - Country:US
Practice Address - Phone:336-350-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician