Provider Demographics
NPI:1396861597
Name:MURDOCK, SUSAN KAY
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:MURDOCK
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 1:2550 W CLINTON AVE BLDG B128-138
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-4206
Mailing Address - Country:US
Mailing Address - Phone:559-225-9117
Mailing Address - Fax:
Practice Address - Street 1:2550 W. CLINTON AVE
Practice Address - Street 2:BUILDING B , # 128-138
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705
Practice Address - Country:US
Practice Address - Phone:559-225-9117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARASM0904041224OtherREGISTERED ADDICTION SPECIALIST