Provider Demographics
NPI:1407607088
Name:NORRIS, MOLLIE RAE
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:RAE
Last Name:NORRIS
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 1:293 CRAIGS MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7723
Mailing Address - Country:US
Mailing Address - Phone:570-269-3247
Mailing Address - Fax:
Practice Address - Street 1:293 CRAIGS MEADOW RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7723
Practice Address - Country:US
Practice Address - Phone:570-269-3247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health