Provider Demographics
NPI:1083622823
Name:MURDOCK, WAULDRED MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:WAULDRED
Middle Name:MARIE
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:WAULDRED
Other - Middle Name:MARIE
Other - Last Name:JONES-MURDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1669 HOWARD PL
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1821
Mailing Address - Country:US
Mailing Address - Phone:516-208-6588
Mailing Address - Fax:
Practice Address - Street 1:1669 HOWARD PL
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1821
Practice Address - Country:US
Practice Address - Phone:516-208-6588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074452-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health