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General NPI Number Information
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NPI Number | 1841234093
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Entity Type | Individual
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Provider Name | RICHARD MURDOCCO LSCW
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 268 N BROADWAY UNIT 6
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City | HICKSVILLE
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State | NY
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Zip | 11801-2923
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Country | US
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Telephone | 631-566-4309
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1559
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City | STONY BROOK
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State | NY
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Zip | 11790-0989
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R025058
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License Number State | NY
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