Provider Demographics
NPI:1073673612
Name:TINTRUP, MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:TINTRUP
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4841
Mailing Address - Country:US
Mailing Address - Phone:203-416-1305
Mailing Address - Fax:203-750-9651
Practice Address - Street 1:1 PARK ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4841
Practice Address - Country:US
Practice Address - Phone:203-416-1305
Practice Address - Fax:203-750-9651
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical