Provider Demographics
NPI:1619723442
Name:MINGO, WHITLEY C (MSW, ECID)
Entity Type:Individual
Prefix:
First Name:WHITLEY
Middle Name:C
Last Name:MINGO
Suffix:
Gender:F
Credentials:MSW, ECID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 PLAINFIELD ST UNIT 211
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1765
Mailing Address - Country:US
Mailing Address - Phone:860-881-4245
Mailing Address - Fax:
Practice Address - Street 1:275 PLAINFIELD ST UNIT 211
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1765
Practice Address - Country:US
Practice Address - Phone:860-881-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula