Provider Demographics
NPI:1558627752
Name:MUCHA, F. BRIAN (CAC)
Entity Type:Individual
Prefix:
First Name:F. BRIAN
Middle Name:
Last Name:MUCHA
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 AMANDA LN
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-1557
Mailing Address - Country:US
Mailing Address - Phone:203-723-4990
Mailing Address - Fax:
Practice Address - Street 1:8 TITUS RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON DEPOT
Practice Address - State:CT
Practice Address - Zip Code:06794-1517
Practice Address - Country:US
Practice Address - Phone:860-868-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor