Provider Demographics
NPI:1043751803
Name:WHITING, MOLLIE (MS BCBA)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:WHITING
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-3375
Mailing Address - Country:US
Mailing Address - Phone:978-973-8192
Mailing Address - Fax:
Practice Address - Street 1:24 HOLLOW LN
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-3375
Practice Address - Country:US
Practice Address - Phone:978-973-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000001716103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst