Basic Information
| Provider Information | |||||||||
| NPI: | 1558683391 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURPHY | ||||||||
| FirstName: | COLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BLISS ST | ||||||||
| Address2: | UNIT E | ||||||||
| City: | MONSON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010571240 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 96 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | WARE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010821616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4139676241 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2010 | ||||||||
| LastUpdateDate: | 12/06/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1300881 | 05 | MA | MEDICAID |