Provider Demographics
NPI:1962439042
Name:MURPHY, SUZANNE M (LICSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:MURPHY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-479-4083
Mailing Address - Fax:802-476-1476
Practice Address - Street 1:23 JONES BROTHERS WAY
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-2527
Practice Address - Country:US
Practice Address - Phone:802-479-4083
Practice Address - Fax:802-476-1476
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00002791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
360327OtherTRICARE
VT989026COtherMVP HEALTHCARE
VT00029834OtherBLUE CROSS/BLUE SHIELD
VT2112165OtherCIGNA
VTOVN1545Medicaid
VT00029834OtherBLUE CROSS/BLUE SHIELD