Individual provider Active NPI

Mujeeb Khalique, M.D.

  • Clinical Child & Adolescent Psychologist
  • West Hartford, CT
National Provider Identifier
1104870252
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
024036 Issued in CT
Practice address
45 S Main St
West Hartford, CT 06107-2441
Phone
(860) 763-7008
Fax
(860) 763-3856
NPI assigned
May 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 024036 CT Primary

Addresses

Primary practice location

45 S Main St
West Hartford, CT 06107-2441

Mailing address

45 S Main St
West Hartford, CT 06107-2402
Phone (860) 763-7008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110122000061 CT Practitioner - Psychiatry 9739368705 Practice locations: West Hartford, CT

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
024036CTMDClinical Child & Adolescent Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1104870252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 S MAIN ST",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072402",
            "telephone_number": "860-763-7008",
            "fax_number": "860-763-3856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 S MAIN ST",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061072441",
            "telephone_number": "860-763-7008",
            "fax_number": "860-763-3856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHALIQUE",
        "first_name": "MUJEEB",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-22",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CT",
            "license": "024036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

Verify at the official NPI Registry.