Provider Demographics
NPI:1902845415
Name:MURDOCK, SUSAN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 MAIN ST
Mailing Address - Street 2:STE 507
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7173
Mailing Address - Country:US
Mailing Address - Phone:703-691-1326
Mailing Address - Fax:703-691-3553
Practice Address - Street 1:10560 MAIN ST
Practice Address - Street 2:STE 507
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7173
Practice Address - Country:US
Practice Address - Phone:703-691-1326
Practice Address - Fax:703-691-3553
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002097103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7703139Medicaid
VA7703139Medicaid
VA685980C34Medicare ID - Type Unspecified