Provider Demographics
NPI:1346781622
Name:MARTINCIN, MOLLY ROSE (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ROSE
Last Name:MARTINCIN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4087 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1435
Mailing Address - Country:US
Mailing Address - Phone:440-787-7877
Mailing Address - Fax:
Practice Address - Street 1:4087 MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1435
Practice Address - Country:US
Practice Address - Phone:614-370-6020
Practice Address - Fax:614-427-5570
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1600156104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker