=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073670816
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MUI MUI HIN-MCCORMICK MS, LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 07/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 148 EASTERN BLVD STE 200
-----------------------------------------------------
City | GLASTONBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06033-4321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-269-3584
-----------------------------------------------------
Fax | 860-812-2014
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 399 CHAMBERLAIN RD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06457-5567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-637-7112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1186
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 001186
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------