Provider Demographics
NPI:1538704663
Name:MURDAUGH, GLENDA (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:
Last Name:MURDAUGH
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BROADWAY FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1073
Mailing Address - Country:US
Mailing Address - Phone:917-270-0338
Mailing Address - Fax:
Practice Address - Street 1:130 LENOX AVENUE
Practice Address - Street 2:APT. 613
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026
Practice Address - Country:US
Practice Address - Phone:917-270-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0599791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical