Provider Demographics
NPI:1497188676
Name:MOLINA, BROOKE SG (PHD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:SG
Last Name:MOLINA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 OHARA ST
Mailing Address - Street 2:UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2593
Mailing Address - Country:US
Mailing Address - Phone:412-246-5664
Mailing Address - Fax:412-246-5650
Practice Address - Street 1:3811 OHARA ST
Practice Address - Street 2:UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2593
Practice Address - Country:US
Practice Address - Phone:412-246-5664
Practice Address - Fax:412-246-5650
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008974L103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent