MEDICARE: MEREDITH MURDOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	143063	CA
2	106H00000X	Marriage & Family Therapist	163511	CA

General Provider Information

NPI Number	:	1063274983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH MURDOCK

Provider Business Mailing Address
First Line	:	PO BOX 1455
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91031-1455
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 GRACE TER
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-3438
Country	:	US
Telephone Number	:	818-326-6030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	05/25/2026

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Directions to “ MEREDITH MURDOCK ” Practice Location

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