Provider Demographics
NPI:1225334600
Name:MOLINA, ROSE A (LICSW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:A
Last Name:MOLINA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 N WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-5146
Mailing Address - Country:US
Mailing Address - Phone:401-255-6906
Mailing Address - Fax:
Practice Address - Street 1:166 LAVAN ST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-1059
Practice Address - Country:US
Practice Address - Phone:401-228-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW021331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical