Healthcare Provider Details

I. General information

NPI: 1639945314
Provider Name (Legal Business Name): MOKIA HULL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 RIDGE ST APT 4
NEW HAVEN CT
06511-2745
US

IV. Provider business mailing address

76 RIDGE ST APT 4
NEW HAVEN CT
06511-2745
US

V. Phone/Fax

Practice location:
  • Phone: 203-988-7353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5578
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: