Provider Demographics
NPI:1346717469
Name:BOSTON, MOLLY (LMSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BOSTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:BRUMIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:821 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2102
Mailing Address - Country:US
Mailing Address - Phone:660-826-4774
Mailing Address - Fax:888-979-8868
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-3821
Practice Address - Country:US
Practice Address - Phone:660-310-0909
Practice Address - Fax:888-979-8868
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180324811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical