Provider Demographics
NPI:1114194495
Name:MURDZA, ANDREA MARIE
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:MARIE
Last Name:MURDZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BEAUCHAMP TER
Mailing Address - Street 2:#5
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4115
Mailing Address - Country:US
Mailing Address - Phone:413-592-0616
Mailing Address - Fax:
Practice Address - Street 1:180 BEAUCHAMP TER
Practice Address - Street 2:#5
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-4115
Practice Address - Country:US
Practice Address - Phone:413-592-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA380961222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist