Provider Demographics
NPI:1225559941
Name:MOLINA, MADELINE (CPL)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
Credentials:CPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 867 KM7.07 PARCELA 133
Mailing Address - Street 2:BO SABANA SECA
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-230-7087
Mailing Address - Fax:
Practice Address - Street 1:CARR 867 KM7. 07 PARCELA 133
Practice Address - Street 2:BO SABANA SECA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-230-7087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1180106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist