Provider Demographics
NPI:1477062107
Name:MORAN, MOLLY ROSE (LMHC, LCMHC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ROSE
Last Name:MORAN
Suffix:
Gender:F
Credentials:LMHC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 HANOVER ST # 1461
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-5419
Mailing Address - Country:US
Mailing Address - Phone:603-688-9228
Mailing Address - Fax:
Practice Address - Street 1:88 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-6445
Practice Address - Country:US
Practice Address - Phone:603-688-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NH2515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health