Provider Demographics
NPI:1770721342
Name:MURDOCK, THERESA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3031
Mailing Address - Country:US
Mailing Address - Phone:914-242-4690
Mailing Address - Fax:
Practice Address - Street 1:295 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:MT. KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-242-4690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-034909-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor