Provider Demographics
NPI:1558967836
Name:MOLLY MARTINCIN LLC
Entity Type:Organization
Organization Name:MOLLY MARTINCIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:MARTINCIN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:440-787-7682
Mailing Address - Street 1:4087 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1435
Mailing Address - Country:US
Mailing Address - Phone:440-787-7682
Mailing Address - Fax:
Practice Address - Street 1:4087 MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1435
Practice Address - Country:US
Practice Address - Phone:614-706-1909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty