Provider Demographics
NPI:1245783737
Name:YOUNG, MOLLY
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MURDOCK ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2223
Mailing Address - Country:US
Mailing Address - Phone:207-939-1129
Mailing Address - Fax:
Practice Address - Street 1:106 MURDOCK ST
Practice Address - Street 2:APT. 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2223
Practice Address - Country:US
Practice Address - Phone:207-939-1129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical