Provider Demographics
NPI:1114472776
Name:MURDOCK, ALLYSON (MS)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LOOMIS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3334
Mailing Address - Country:US
Mailing Address - Phone:802-448-0524
Mailing Address - Fax:
Practice Address - Street 1:133 BLAKELY RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4007
Practice Address - Country:US
Practice Address - Phone:802-448-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF96786106H00000X
VT097.0134166106H00000X
VT100.0134008106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist