Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 016313-1 | NY |
N | 103TC0700X | Clinical Psychologist | 016313-1 | NY |
N | 103G00000X | Clinical Psychologist | 4870 | NC |
N | 103TC0700X | Clinical Psychologist | 4870 | NC |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 016313-1 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 4870 | NC |
Y | 103TH0100X | Health Service | 4870 | NC |
NPI | 1174738181 |
---|---|
Provider Name | Dr. Peregrine Murphy Kavros |
First Address | Hillsborough, NC 27278-8519 |
Second Address | Hillsborough, NC 27278-8519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2007 |
Last Update Date | 10/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11496523 | CAQH (01) |