Provider Demographics
NPI:1427755560
Name:MUHAMMAD, KEVIN (LMSW)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MUHAMMAD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3234 TOWN WALK DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3706
Mailing Address - Country:US
Mailing Address - Phone:203-440-5170
Mailing Address - Fax:
Practice Address - Street 1:4270 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2306
Practice Address - Country:US
Practice Address - Phone:204-440-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT129651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical