Provider Demographics
NPI:1023432044
Name:MURDOCK, JENNY ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:ELIZABETH
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 1:220 S COURTENAY PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4893
Mailing Address - Country:US
Mailing Address - Phone:321-868-5815
Mailing Address - Fax:321-453-2994
Practice Address - Street 1:220 S COURTENAY PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4893
Practice Address - Country:US
Practice Address - Phone:321-868-5815
Practice Address - Fax:321-453-2994
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW117001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical