Provider Demographics
NPI:1164621264
Name:MCMURTRY, DOUGLAS FREDERICK (MSW, LICSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:FREDERICK
Last Name:MCMURTRY
Suffix:
Gender:M
Credentials:MSW, LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4044
Mailing Address - Country:US
Mailing Address - Phone:716-839-3012
Mailing Address - Fax:716-839-3012
Practice Address - Street 1:193 AUDUBON DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4044
Practice Address - Country:US
Practice Address - Phone:716-839-3012
Practice Address - Fax:716-839-3012
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078447-11041C0700X
MA1062061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical