Provider Demographics
NPI:1093994428
Name:MOLL, DOUGLAS DAVID (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DAVID
Last Name:MOLL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4968 GLENWAY AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3902
Mailing Address - Country:US
Mailing Address - Phone:513-557-2810
Mailing Address - Fax:
Practice Address - Street 1:4968 GLENWAY AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3902
Practice Address - Country:US
Practice Address - Phone:513-557-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6347103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist