Provider Demographics
NPI:1003039793
Name:MURDOCK, KAREN (MT1879)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:MT1879
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 TAMIAMI TRL S
Mailing Address - Street 2:SUITE 703
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-5570
Mailing Address - Country:US
Mailing Address - Phone:941-587-7672
Mailing Address - Fax:
Practice Address - Street 1:1531 TAMIAMI TRL S
Practice Address - Street 2:SUITE 703
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5570
Practice Address - Country:US
Practice Address - Phone:941-587-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1879106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000218700Medicaid