Provider Demographics
NPI:1174630974
Name:MURDOCK, DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20270 SPRUCEGROVE SQ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-2390
Mailing Address - Country:US
Mailing Address - Phone:703-723-6090
Mailing Address - Fax:
Practice Address - Street 1:44790 MAYNARD SQ STE 130
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6514
Practice Address - Country:US
Practice Address - Phone:703-542-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040037711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA298369OtherAMERIGROUP
VA183941OtherANTHEM
VA8926166Medicaid
VA183944OtherANTHEM
VA183941OtherANTHEM
VA800010643Medicare ID - Type UnspecifiedMEDICARE-RAILROAD
VA800002585Medicare ID - Type UnspecifiedTRAILBLAZER MEDICARE