Healthcare Provider Details

I. General information

NPI: 1588596084
Provider Name (Legal Business Name): MHMP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CENTERPOINT DR STE 901
MIDDLETOWN CT
06457-7570
US

IV. Provider business mailing address

515 CENTERPOINT DR STE 901
MIDDLETOWN CT
06457-7570
US

V. Phone/Fax

Practice location:
  • Phone: 203-918-4488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARYFRANCES DESTENO
Title or Position: PROVIDER
Credential: APRN
Phone: 203-918-4488