Provider Demographics
NPI:1033237888
Name:MOMPARLER, MICHAEL (MSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MOMPARLER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 REED CT
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2533
Mailing Address - Country:US
Mailing Address - Phone:860-388-8831
Mailing Address - Fax:203-932-5478
Practice Address - Street 1:18 REED CT
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2533
Practice Address - Country:US
Practice Address - Phone:860-388-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0010991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical