Provider Demographics
NPI:1679668677
Name:MUFSON, KENNETH JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JOHN
Last Name:MUFSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:255 STRAWBERRY HILL AV
Mailing Address - Street 2:#B15
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-323-9022
Mailing Address - Fax:203-323-5375
Practice Address - Street 1:255 STRAWBERRY HILL AV
Practice Address - Street 2:#B15
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-323-9022
Practice Address - Fax:203-323-5375
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0027741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical