| Muck Mudd Inc. | |
|
955 Connecticut Ave Ste 5202 Bridgeport CT 06607-1248 | |
| (203) 440-5170 | |
| Not Available |
| Full Name | Muck Mudd Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 955 Connecticut Ave Ste 5202, Bridgeport, Connecticut |
| Authorized Official Name and Position | Kevin Muhammad (OWNER) |
| Authorized Official Contact | 2034405170 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Muck Mudd Inc. 955 Connecticut Ave Ste 5202 Bridgeport CT 06607-1248 Ph: (203) 440-5170 | Muck Mudd Inc. 955 Connecticut Ave Ste 5202 Bridgeport CT 06607-1248 Ph: (203) 440-5170 |
| NPI Number | 1073201984 |
|---|---|
| Provider Enumeration Date | 04/27/2023 |
| Last Update Date | 04/27/2023 |
| Certification Date | 04/27/2023 |
| Medicare PECOS PAC ID | 2567806706 |
|---|---|
| Medicare Enrollment ID | O20240215003617 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073201984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kevin Muhammad |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427755560 PECOS PAC ID: 3476997610 Enrollment ID: I20240215003685 |
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