Healthcare Provider Details

I. General information

NPI: 1124844683
Provider Name (Legal Business Name): MUHAMMED VAHID LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 GLEN RD
SANDY HOOK CT
06482-1170
US

IV. Provider business mailing address

75 GLEN RD STE G03
SANDY HOOK CT
06482-1197
US

V. Phone/Fax

Practice location:
  • Phone: 203-837-6270
  • Fax:
Mailing address:
  • Phone: 203-837-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9932
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: