Provider Demographics
NPI:1326478884
Name:SITA-MOLZ, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:SITA-MOLZ
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:ANTONETA
Other - Last Name:SITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:401 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3459
Mailing Address - Country:US
Mailing Address - Phone:516-604-1940
Mailing Address - Fax:
Practice Address - Street 1:401 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3459
Practice Address - Country:US
Practice Address - Phone:516-604-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical