Provider Demographics
NPI:1619204674
Name:MY PEOPLE CLINCIAL SERVICES, LLC
Entity Type:Organization
Organization Name:MY PEOPLE CLINCIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDUL-RAHMAAN
Authorized Official - Middle Name:IBN
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:860-656-0450
Mailing Address - Street 1:695 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1506
Mailing Address - Country:US
Mailing Address - Phone:860-656-0450
Mailing Address - Fax:860-656-0491
Practice Address - Street 1:695 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1506
Practice Address - Country:US
Practice Address - Phone:860-656-0450
Practice Address - Fax:860-656-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty