Healthcare Provider Details

I. General information

NPI: 1164958997
Provider Name (Legal Business Name): PARKER MILLS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 BROAD ST
MIDDLETOWN CT
06457-3204
US

IV. Provider business mailing address

51 BROAD ST
MIDDLETOWN CT
06457-3204
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-3445
  • Fax: 860-358-3403
Mailing address:
  • Phone: 860-358-3445
  • Fax: 860-358-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number009602
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: