Provider Demographics
NPI:1376250266
Name:BEEN, MOLLY KATE
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATE
Last Name:BEEN
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 1:17 UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4021
Mailing Address - Country:US
Mailing Address - Phone:479-259-3631
Mailing Address - Fax:
Practice Address - Street 1:75 NORTH BEACON STREET
Practice Address - Street 2:FL 2
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472
Practice Address - Country:US
Practice Address - Phone:617-850-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health