Provider Demographics
NPI:1497859599
Name:MURTHY, VASUDEVA CHIKKATUR (LCSWR LCSW)
Entity Type:Individual
Prefix:MR
First Name:VASUDEVA
Middle Name:CHIKKATUR
Last Name:MURTHY
Suffix:
Gender:M
Credentials:LCSWR LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25403 84TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1009
Mailing Address - Country:US
Mailing Address - Phone:516-209-4843
Mailing Address - Fax:801-708-0844
Practice Address - Street 1:38 W 32ND ST STE 1511
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3875
Practice Address - Country:US
Practice Address - Phone:917-215-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041S0200X
NYR044004011041C0700X
NJ44SC013334001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02861356Medicaid
NY37199POtherHIP
509078925OtherUNITED BEHAVIORAL HEALTH
NY0152444OtherGHI
NYR044004OtherMETROPLUS
2324784OtherCIGNA
NY562616952OtherMANGA CARE
OH570069OtherVALUE OPTIONS
R044004OtherAETNA
NY02861356Medicaid