Provider Demographics
NPI:1841234093
Name:MURDOCCO, RICHARD (LSCW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:MURDOCCO
Suffix:
Gender:M
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:268 N BROADWAY
Practice Address - Street 2:UNIT 6
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-2923
Practice Address - Country:US
Practice Address - Phone:631-566-4309
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0250581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02043956Medicaid
NYN08461OtherEMPIRE BC.BS
NYN08461OtherEMPIRE BC.BS
NYS05328Medicare UPIN