Healthcare Provider Details

I. General information

NPI: 1497859599
Provider Name (Legal Business Name): VASUDEVA CHIKKATUR MURTHY LCSWR LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 W 32ND ST STE 1511
NEW YORK NY
10001-3875
US

IV. Provider business mailing address

25403 84TH DRIVE
FLORAL PARK NY
11001-1009
US

V. Phone/Fax

Practice location:
  • Phone: 917-215-2169
  • Fax:
Mailing address:
  • Phone: 516-209-4843
  • Fax: 801-708-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR04400401
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC01333400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: