Provider Demographics
NPI:1407553332
Name:MESIANO, MOLLY (MS)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MESIANO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-5743
Mailing Address - Country:US
Mailing Address - Phone:904-451-8396
Mailing Address - Fax:
Practice Address - Street 1:5150 PALM VALLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4630
Practice Address - Country:US
Practice Address - Phone:904-746-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health