Provider Demographics
NPI:1962466193
Name:MURPHY, JUDITH BRAM (PHD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:BRAM
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 E 69TH ST
Mailing Address - Street 2:APT. 11C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5108
Mailing Address - Country:US
Mailing Address - Phone:212-517-5707
Mailing Address - Fax:
Practice Address - Street 1:274 MADISON AVE
Practice Address - Street 2:SUITE 1204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0701
Practice Address - Country:US
Practice Address - Phone:212-725-9862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2013-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013808-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01943315Medicaid