Provider Demographics
NPI:1073201984
Name:MUCK MUDD INC.
Entity Type:Organization
Organization Name:MUCK MUDD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-440-5170
Mailing Address - Street 1:955 CONNECTICUT AVE STE 5202
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06607-1248
Mailing Address - Country:US
Mailing Address - Phone:203-440-5170
Mailing Address - Fax:
Practice Address - Street 1:955 CONNECTICUT AVE STE 5202
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06607-1248
Practice Address - Country:US
Practice Address - Phone:203-440-5170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty